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World J Clin Cases. May 16, 2022; 10(14): 4691-4697 Published online May 16, 2022. doi: 10.12998/wjcc.v10.i14.4691
Suprasellar cistern tuberculoma presenting as unilateral ocular motility disorder and ptosis: A case report
Bi-Bo Zhao, Chao Tian, Le-Jun Fu, Xue-Bin Zhang
Bi-Bo Zhao, Chao Tian, Le-Jun Fu, Department of Radiology, Tianjin Huanhu Hospital, Tianjin 300350, China
Xue-Bin Zhang, Department of Pathology, Tianjin Huanhu Hospital, Tianjin 300350, China
Author contributions: All authors provided intellectual contributions to this manuscript; Zhao BB drafted the manuscript, prepared the figures, conducted data acquisition and performed the background literature review; Fu LJ participated in the acquisition and interpretation of radiologic images; Zhang XB analyzed and confirmed the pathological results; Tian C reviewed and revised the manuscript and supervised the study; all authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient’s parents for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Received: December 10, 2021 Peer-review started: December 10, 2021 First decision: January 26, 2022 Revised: February 6, 2022 Accepted: March 16, 2022 Article in press: March 16, 2022 Published online: May 16, 2022
Abstract
BACKGROUND
Intracranial tuberculoma is a rare and serious type of tuberculosis, which mostly occurs in the frontoparietal and cerebellar hemispheres, with predominance in the gray-white matter junction area, while tuberculomas only in the cistern are extremely rare with only a few reported cases in the literature. We describe a unique case of isolated tuberculoma in the suprasellar cistern, with only right ocular motility disorder and upper eyelid ptosis.
CASE SUMMARY
A 5-year-old boy without any medical history presented with right ocular motility disorder and upper eyelid ptosis one month ago. He had no history of fever, headache, vomiting, convulsions, or limb weakness. Neurological examination showed right third cranial nerve palsy with restrictions of eye movements and ptosis, pupil dilation and negative light reflex. Imaging suggested a space-occupying lesion in the suprasellar cistern with calcification and ring-enhancement. Moreover, no Mycobacterium tuberculosis was found in cerebrospinal fluid by polymerase chain reaction (PCR). The lesion was initially diagnosed as a tumor, while postoperative pathology combined with PCR indicated tuberculoma. The patient continued postoperative anti-tuberculosis treatment. At present, the patient's condition is stable and the symptoms are partially relieved compared with those before surgery.
CONCLUSION
This case confirmed that isolated intracranial tuberculoma can occur in the suprasellar cistern. Therefore, for space-occupying lesions in the suprasellar cistern, tuberculoma should be included in the differential diagnosis even if there is no history or indication of tuberculosis infection.
Core Tip: Intracranial tuberculoma is a rare and serious type of tuberculosis, which mostly occurs in the frontoparietal and cerebellar hemispheres, with predominance in the gray-white matter junction area, while tuberculomas only in the cistern are extremely rare. Isolated intracranial tuberculoma in the suprasellar cistern mimicking a tumor with only ocular symptoms has not been reported before. This case confirmed that isolated intracranial tuberculoma can occur in the suprasellar cistern. Therefore, for space-occupying lesions in the suprasellar cistern, tuberculoma should be included in the differential diagnosis even if there is no history or indication of tuberculosis infection.
