Cavernous sinus tuberculoma is an exceedingly rare manifestation of central nervous system (CNS) tuberculosis, posing significant diagnostic challenges due to its atypical location and resemblance to neoplastic lesions on imaging. This report describes a 12-year-old male from a tuberculosis-endemic region who presented with headache and diplopia. Magnetic resonance imaging (MRI) brain revealed a homogeneously enhancing lesion in the left cavernous sinus. Differential diagnoses included neoplastic and inflammatory etiologies. A chest X-ray and positron emission tomography-computed tomography (PET-CT) identified mediastinal lymphadenopathy, from which a biopsy confirmed Mycobacterium tuberculosis . Anti-tubercular therapy (ATT) and corticosteroids led to complete clinical and radiologic resolution over 12 months. This case underscores the importance of considering TB in atypical intracranial presentations, particularly in endemic areas. Diagnosis may require an extrapulmonary biopsy due to the inaccessibility of CNS lesions. Early empiric therapy is essential to prevent neurological sequelae.
Yadav et al. (Thu,) studied this question.