Importance of contrast-enhanced fluid-attenuated inversion recovery imaging to detect paradoxical expansion of tuberculoma.

Tuberculosis is a significant public health problem that continues to be a major cause of morbidity and mortality worldwide. Tuberculous meningoencephalitis (TM) is the most common extrapulmonary lesion in tuberculosis. A 41-year-old female was thought to have TM. Tests to confirm the TM diagnosis were initially negative, including tuberculosis PCR and adenosine deaminase level in serum and cerebrospinal fluid (CSF). Anti-tuberculous medication and intravenous steroids were administered to her on the basis of brain imaging and lactate dehydrogenase electrophoresis in CSF, suggestive of the diagnosis of TM. Her neurological problems improved rapidly following treatment. Serologic and CSF markers were positive in PCR and culture after 60 days. Radiological findings are often nonspecific and TM is difficult to diagnose without an increased index of suspicion. The detection of paradoxical expansion of tuberculoma is very important in the maintenance of medication. Magnetic resonance imaging was used to detect paradoxical expansion of the tuberculoma using various methods, such as contrast-enhanced fluid-attenuated inversion recovery (CE-FLAIR) imaging. CE-FLAIR imaging conspicuously showed paradoxical expansion of the tuberculoma. If patients present with clear meningitis, without any identified pathogen, there is a need to constantly and scrupulously check for TM, including with the use of CE-FLAIR brain imaging.