CNS Tuberculoma in a Patient of Acute Lymphoblastic Leukemia: A Rare Case Report

Abstract

Patients with acute leukemia are immunocompromised and highly susceptible to infections. Central nervous system tuberculoma is a rare but serious complication in immunocompromised patients, particularly those undergoing treatment for hematological malignancies. Early diagnosis is often challenging due to non-specific symptoms. We report the case of a 28-year-old female recently diagnosed with CALLA-positive B-cell Acute Lymphoblastic Leukemia, who presented with a two-month history of low-grade fever. Induction chemotherapy was initiated, but during the third week of treatment, she developed new-onset seizures. A Computed Tomography scan of the brain revealed a heterogeneous ring-enhancing lesion in the right parietal lobe. Magnetic Resonance Imaging with MR spectroscopy demonstrated characteristic lipid peaks, supporting the diagnosis of a tuberculoma. Antitubercular therapy including rifampicin, isoniazid, pyrazinamide, ethambutol, along with pyridoxine and dexamethasone, was commenced. The patient showed a favourable response, with resolution of fever and no recurrence of seizures. This case underscores the importance of considering CNS tuberculosis in the differential diagnosis of unexplained neurological symptoms and fever in patients with acute leukemia, particularly in regions where tuberculosis is endemic. Prompt diagnosis and treatment can lead to favourable outcomes.