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Large Tuberculous Mass Lesions Involving the Brain: Outcomes and Management

Prasannakumar Palanikumar Department of Infectious Diseases, Christian Medical College, Vellore, India;

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Priyanka Gautam Department of Infectious Diseases, Christian Medical College, Vellore, India;

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Harshad Arvind Vanjare Department of Radiology, Christian Medical College, Vellore, India;

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Nagaraj Veerasamy Department of Infectious Diseases, Christian Medical College, Vellore, India;

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Mithun Mohan George Department of Infectious Diseases, Christian Medical College, Vellore, India;

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Leeberk Raja Inbaraj Department of Clinical Research, Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India;

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Edmond Jonathan Gandham Division of Neurosurgery, Christian Medical College, Vellore, India;

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Ajith Sivadasan Division of Neurology, Department of Neurological Sciences, Christian Medical College, Vellore, India

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Rajiv Karthik Department of Infectious Diseases, Christian Medical College, Vellore, India;

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Abi Manesh Department of Infectious Diseases, Christian Medical College, Vellore, India;

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DOI:
https://doi.org/10.4269/ajtmh.24-0376
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Ahead of Print
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The optimal management of large tuberculous mass lesions (LTML) involving the central nervous system remains unclear. We conducted a single-center, retrospective, observational study that assessed the outcomes of patients with LTML from January 2010 to February 2023. An LTML was defined as a tuberculoma or tubercular abscess exceeding or equal to 3 cm. The primary outcome was independence in activities of daily living, as assessed by the modified Rankin Scale (mRS) at a follow-up of 6 months. Forty-six patients were identified during the study period. Their mean age was 27.6 ± 12 years, the median duration of antituberculous therapy (ATT) was 18 months, and the median duration of follow-up was 20 months (interquartile range 15.7–40). The favorable outcomes were 76.9% (10/13) for ATT alone, 62.5% (10/16) for ATT with steroids, 87.5% (7/8) for ATT with surgery, and 66.9% (6/9) for ATT, steroids, and surgery. The median mRS at baseline in the study was 2 (1–3), and at the 6 month follow-up, it was 1 (0–2). Adding steroids or surgical intervention to ATT did not significantly improve primary outcomes (P = 0.637). Further large-scale studies are necessary to confirm these preliminary observations.

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Author Notes

Disclosures: Ethical approval was obtained from the Institutional Review Board (IRB Min No. 15352) of Christian Medical College and Hospital, Vellore, Tamil Nadu, India. The IRB waived participant consent as this is a retrospective study. Additionally, all methods were performed following the relevant guidelines and regulations. Data are available upon reasonable request to the corresponding author. The authors report no conflicts of interest.

Authors’ contributions: A. Manesh conceptualized the study. P. Palanikumar and P. Gautam collected and managed the data. H. A. Vanjare provided the radiological assessment and images. P. Gautam and N. V. conducted the statistical analysis. P. Palanikumar, P. Gautam, and A. Manesh wrote the original draft. M. M. George, L. R. Inbaraj, E. J. Gandham, A. Sivadasan, and R. Karthik provided the critical review. All authors had access to the raw data, reviewed and approved the final manuscript, and agreed to submit the manuscript for publication.

Current contact information: Prasannakumar Palanikumar, Priyanka Gautam, Nagaraj V, Mithun Mohan George, Rajiv Karthik, and Abi Manesh, Department of Infectious Diseases, Christian Medical College, Vellore, India, E-mails: prasannakumar.p@cmcvellore.ac.in, priyanka91gautam@gmail.com, 17bst029@gmail.com, mithunmohangeorge@gmail.com, rajiv@cmcvellore.ac.in, and abimanesh@gmail.com. Harshad Arvind Vanjare, Department of Radiology, Christian Medical College, Vellore, India, E-mail: harshadcmc2022@gmail.com. Leeberk Raja Inbaraj, Department of Clinical Research, Indian Council of Medical Research—National Institute for Research in Tuberculosis, Chennai, India, E-mail: leeberk2003@gmail.com. Edmond Jonathan Gandham, Division of Neurosurgery, Christian Medical College, Vellore, India, E-mail: gandham.edmond@cmcvellore.ac.in. Ajith Sivadasan, Division of Neurology, Department of Neurological Sciences, Christian Medical College, Vellore, India, E-mail: ajithsivadasan@yahoo.com.

Address correspondence to Abi Manesh, Department of Infectious Diseases, Christian Medical College, Ida Scudder Rd., Vellore 632004, India. E-mail: abimanesh@cmcvellore.ac.in
Copyright:
© American Society of Tropical Medicine and Hygiene 2025
Received:
11 Jun 2024
|
Accepted:
18 Jan 2025
|
Published Online:
01 Apr 2025
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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