Central nervous system tuberculoma in children: tertiary hospital experience in Turkey in the last quarter century.

Abstract

Introduction: Tuberculomas represent a significant complication of central nervous system (CNS) infection resulting from tuberculosis. The objective of our study was to evaluate the demographic and clinical characteristics, diagnosis, treatment, and prognosis of pediatric patients with CNS tuberculoma.

Methods: The study population comprised patients aged 0-18 years who were diagnosed with CNS tuberculoma in the Division of Pediatric Infectious Diseases at Cukurova University Balcali Hospital between January 1, 2002, and September 1, 2024. A retrospective analysis was conducted on the files to examine the demographic and clinical characteristics, radiological data, and treatment of the patients. The definitive diagnosis was established through acid-fast bacilli staining and tuberculosis culture of the CNS lesion. The probable diagnosis was made on the basis of clinical epidemiologic factors, histopathology, molecular methods, and typical radiographic findings.

Results: CNS was tuberculoma detected in 22 patients (8.3%) of the 265 individuals diagnosed with TB. Of the total number of patients, 12 (54.5%) were male and 10 (45.5%) were female. The median age of the patients was 60 months (25th to 75th interquartile range 15.8 and 144.0, respectively), and the most common presenting complaint was fever (77.3%). A lumbar puncture was conducted in 19 patients (86.4%), and brain imaging was performed on all of them. Biopsies from the brain lesions were obtained in two patients. The mean follow-up period was 9.3 ± 5.4 years. The antituberculosis treatment was administered until the lesions had disappeared. Complete recovery was observed in 14 patients (63.6%), while eight patients (36.4%) exhibited sequelae. Tuberculoma did not result in mortalities among the patients.

Conclusion: Diagnosis of CNS tuberculoma is often difficult due to non-specific symptoms and difficulties in sampling. Early diagnosis and appropriate treatment can prevent mortality and morbidity. When we encounter suspicious radiologic findings in brain imaging, especially magnetic resonance imaging, it should be considered in the differential diagnosis.