Diagnostic dilemma and therapeutic non-compliance in a case of intracranial tuberculoma

A case of extensive intracranial tuberculoma is presented. The patient had been treated for 5 years with a standard antituberculosis regimen but she had been grossly non-compliant. This had led to emergence of multi-resistant Mycobacterium tuberculosis producing progressive disease and extensive cranial nerve damage and proptosis. The unusual CT and angiographic appearances cast doubt on the original diagnosis and a brain biopsy was necessary. Mycobacterium tuberculosis resistant to isoniazid, rifampicin, ethambutol, ethionamide, pyrazinamide, clofazimine and PAS was cultured from the brain biopsy specimen and from an associated groin abscess. A novel regimen of isoniazid, cycloserine, amikacin and ciprofloxacin produced clinical improvement of symptoms and radiological resolution.