From tumor suspicion to tuberculoma discovery: A pregnancy case report and literature review

This article presents the case of a 22-year-old woman at 29 weeks of pregnancy, who exhibited recent onset neurologic symptoms including paresthesia of the right side of the face, involuntary myoclonic movements in the ipsilateral hand, 1 week of weakness in the right side of the body, and imaging features that were highly suggestive of a brain tumor diagnosis. A challenging decision making process was conducted by a team of multidisciplinary experts, leading to a consensus on adopting a conservative approach involving the use of steroids and antiepileptic medications, to which the patient responded favorably. When the patient reached 34 weeks of pregnancy, a cesarean section was performed, without complications, with the delivery of a healthy premature newborn. Upon delivery, surgical resection of the brain lesion was performed. Histopathologic analysis of the biopsy did not show signs consistent with neoplasia. Instead, it highlighted areas of necrosis along with the presence of granulomas and giant cells. Notably, despite extensive testing and staining for tuberculous bacilli across multiple samples yielding negative results, definitive confirmation was only secured via a gene X-pert test on the biopsied tissue. This diagnostic process emphasizes the importance of considering infectious diseases in atypical cases, highlighting the complexity of neurologic symptom assessment during pregnancy and the need to explore epidemiologic, systemic, and personal history factors.