Late clinical manifestation of cerebral tuberculomas in two children with tuberculous meningoencephalitis

We report on two children with cerebral tuberculomas leading to late dramat ic clinical exacerbation after appropriate antituberculous chemotherapy and high-dose corticosteroids. A 6-year-old girl with tuberculous meningoencep halitis initially fully recovered. However. after 9 months of continuous th erapy she presented with acute increased intracranial pressure caused by tu berculomas requiring rapid drainage of CSF. A 16-year-old boy with miliary pulmonary tuberculosis and severe meningoencephalitis had reached a stable condition for more than 10 months although still suffering from a left-domi nant spasticity and motor dysphasia. Fifteen months after initiation of the rapy he presented with an acute central paralysis of the left facial nerve, progressive hemiplegia, severe ataxia and increasing lethargy caused by a cerebral tuberculoma with a perifocal oedema. Prolonged treatment with anti tuberculous chemotherapy and high-dose corticosteroids led to complete reco very in the younger patient and marked improvement in he older patient who remains severely handicapped. Conclusion: Patients with initially successfu l treatment of central nervous system tuberculosis should undergo an alert follow-up for the development of late cerebral tuberculomas. Treatment shou ld consist of prolonged courses of antituberculous chemotherapy and highdos e corticosteroids.