Giant Tuberculoma Resembling Brain Tumor in a Child

13 years old child from tribal area of Khyber Pakhtunkhwa presented to us with chief complaints of headache and vomiting for last 3 months with recent onset of aggressive behavior. Patient had normal neu-rological examination except that he had frontal lobe release signs and bilateral papilledema. MRI scan of brain showed a large ring enhancing lesion measuring 5x6x5 cm in the frontal lobe with surrounding edema (Figures 1 – 3). Because of Short history and relevant MRI picture diagnosis of high grade glioma was made. Though there was history of tuberculosis in the family but because of large size of the lesion with short his-tory with no fever or cough the differential of tubercu-loma was not considered before surgery. Routine in-vestigations were unremarkable. Patient was prepared and put on elective list for craniotomy and excision of the lesion. During surgery patient brain was edematous so patient was hyperventilated and mannitol was given before opening the dura. Per operatively the lesion was fibrous, firm and not easily removable as is the case with high grade glioma and gross total resection was not possible because of brain edema and respiratory distress. Biopsy was taken and subtotal resection was performed. Patient was put on ATT and metastastic work up also advised started. Histopathology report showed a caseating granulomatous lesion (Figure 4)