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.