Case report: CNS tuberculoma in a patient with prior pulmonary tuberculosis

Central nervous system (CNS) tuberculoma is a rare but severe form of tuberculosis (TB) that can mimic other neurological disorders and poses major diagnostic challenges, especially with drug resistance. We report a case of a woman in her 60s who developed CNS tuberculoma four years after completing anti-tuberculosis therapy (ATT) for pulmonary TB. She presented with progressive left-sided weakness, facial asymmetry, and dysphagia. MRI revealed a ring-enhancing lesion in the right caudate nucleus with a lipid-lactate peak on spectroscopy, consistent with tuberculoma. Drug susceptibility testing confirmed resistance to isoniazid and rifampicin, indicating multidrug-resistant TB (MDR-TB). A modified regimen with levofloxacin, ethionamide, and para-aminosalicylic acid led to neurological recovery. This case underscores the importance of considering CNS tuberculoma in patients with neurological deficits and prior TB, even after apparent cure. Early neuroimaging, drug resistance testing, and individualized therapy are vital to improving outcomes and reducing morbidity and mortality.