BMC infectious diseases · 2026
Cerebral tuberculoma in pregnancy (Jan 1975-May 2025): a systematic review and descriptive analysis of 33 published cases.
СтатьяСистематический обзорНазвание и аннотация: Перевод в очереди
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Rebellón-Sánchez David E, Vinueza Daniela, Castro Restrepo David E, Llanos Julio Alfredo, Rosso Fernando
Аннотация
BACKGROUND: Cerebral tuberculoma is an infrequent but life-threatening manifestation of tuberculosis whose diagnosis and treatment are uniquely complicated by pregnancy-related physiological changes. Evidence to guide clinicians remains fragmented and largely anecdotal.
METHODS: We systematically searched MEDLINE, LILACS and grey literature to May 2025 for reports of cerebral tuberculoma in pregnant or postpartum women. Twenty-seven studies (24 case reports, 2 descriptive studies, 1 case series) from 20 countries met inclusion criteria, yielding individual-level data on 33 patients. Demographics, clinical features, diagnostics, management and maternal-fetal outcomes were extracted and synthesized.
RESULTS: Median maternal age was 26 years (IQR 23-29). Diagnosis occurred ante-partum in 45% and post-partum in 55%, at a median gestational age of 31 weeks. Headache (59%), fever (56%) and seizures (48%) predominated; cranial-nerve palsies (54%) and focal paresis (50%) were common neurologic signs. Magnetic resonance imaging (MRI) revealed solitary or multiple contrast-enhancing lesions, chiefly supratentorial but infratentorial in 35%. Cerebrospinal fluid (CSF) showed proteinorrachia (n = 10/15) and mononuclear pleocytosis (n = 8/12, 66.67%); positivity of CSF or biopsy interferon-γ release assays (100%, n = 3/3) outperformed CSF culture (33.3%, n = 3/9) and CSF polymerase chain reaction (PCR; 12.5%, n = 1/8). Standard four-drug therapy plus corticosteroids was administered in 97%, typically > 12 months; 60% underwent neurosurgical biopsy or resection. Maternal mortality was 4.6%, and persistent neurological sequelae occurred in 33.3% of cases (n = 7/21). Among 26 live pregnancies, preterm delivery occurred in 72%; neonatal complications affected 50%, including congenital tuberculosis (17%) and neonatal death (17%).
CONCLUSIONS: Although cerebral tuberculoma during pregnancy is rare, delayed recognition contributes to substantial maternal morbidity and adverse neonatal outcomes. Our synthesis underscores the diagnostic value of advanced imaging and CSF interferon-γ assays, supports prolonged first-line therapy with adjunctive steroids, and highlights critical gaps in evidence-based guidelines. Multicentre prospective registries are urgently needed to refine diagnostic algorithms and optimise maternal-fetal care.
METHODS: We systematically searched MEDLINE, LILACS and grey literature to May 2025 for reports of cerebral tuberculoma in pregnant or postpartum women. Twenty-seven studies (24 case reports, 2 descriptive studies, 1 case series) from 20 countries met inclusion criteria, yielding individual-level data on 33 patients. Demographics, clinical features, diagnostics, management and maternal-fetal outcomes were extracted and synthesized.
RESULTS: Median maternal age was 26 years (IQR 23-29). Diagnosis occurred ante-partum in 45% and post-partum in 55%, at a median gestational age of 31 weeks. Headache (59%), fever (56%) and seizures (48%) predominated; cranial-nerve palsies (54%) and focal paresis (50%) were common neurologic signs. Magnetic resonance imaging (MRI) revealed solitary or multiple contrast-enhancing lesions, chiefly supratentorial but infratentorial in 35%. Cerebrospinal fluid (CSF) showed proteinorrachia (n = 10/15) and mononuclear pleocytosis (n = 8/12, 66.67%); positivity of CSF or biopsy interferon-γ release assays (100%, n = 3/3) outperformed CSF culture (33.3%, n = 3/9) and CSF polymerase chain reaction (PCR; 12.5%, n = 1/8). Standard four-drug therapy plus corticosteroids was administered in 97%, typically > 12 months; 60% underwent neurosurgical biopsy or resection. Maternal mortality was 4.6%, and persistent neurological sequelae occurred in 33.3% of cases (n = 7/21). Among 26 live pregnancies, preterm delivery occurred in 72%; neonatal complications affected 50%, including congenital tuberculosis (17%) and neonatal death (17%).
CONCLUSIONS: Although cerebral tuberculoma during pregnancy is rare, delayed recognition contributes to substantial maternal morbidity and adverse neonatal outcomes. Our synthesis underscores the diagnostic value of advanced imaging and CSF interferon-γ assays, supports prolonged first-line therapy with adjunctive steroids, and highlights critical gaps in evidence-based guidelines. Multicentre prospective registries are urgently needed to refine diagnostic algorithms and optimise maternal-fetal care.