CASE REPORT:
A 45-year-old male was referred to the hospital due to failed Left
Arteriovenous fistula. He was a known case of chronic kidney disease
(CKD) and Hypertension for 10 years. Past Medical History includes an
episode of Generalized Tonic-Clonic seizures (GTCS) which was further
managed in a tertiary care hospital. There was no history of past HIV,
Hepatitis, and TB infection. Additionally, there was no history of any
trauma or alcohol abuse.
On admission, the patient was hemodynamically stable and oxygen
saturation at room air was 100%. Respiratory system examination
revealed normal vesicular breath sound in the chest without any
adventitious sounds and cardiovascular examination revealed normal heart
sounds without any murmur. The abdomen was soft without any tenderness
and organomegaly. On neurological evaluation, right side upper and lower
limb tone was increased. Deep tendon reflexes and muscle power on both
upper and lower limbs were normal. Sensory function, cranial nerve, and
higher function were within normal limits. On the 4thday of admission, he developed 3 episodes of Generalized Tonic-Clonic
seizures (GTCS) within a 3-hour duration and were subsequently
stabilized with Midazolam.
Computed tomography (CT) scan of the brain was performed which revealed
a cystic ring-enhancing lesion seen with surrounding edema in the left
frontal lobe. (Fig. 1)
Magnetic resonance imaging (MRI) of the brain showed a relatively
well-defined altered signal intensity lesion of size 2.47cm *1.76cm in
the left frontal lobe, appearing predominantly hyperintense with
peripheral hypointense rim with significant perilesional edema. (Fig. 2)
Imaging guided Biopsy was performed. Histopathological examination was
suggestive of necrotizing granulomatous inflammation diagnostic of
tuberculoma. Hence, ATT was initiated and left frontal craniotomy was
performed and the mass lesion was excised in view of lesion size, edema,
and its compressive effects. (Fig. 3 and 4)
Postoperatively, the patient was started on anti-tubercular,
anti-seizure medications and is on regular follow up doing well without
any further complains of seizures.