Sellar and Suprasellar Tuberculoma: a case report
The present case has been reported in the Indian Journal of Neurosurgery.

A 19-year-old male was referred as a follow- up case of tuberculous meningitis and was on antitubercular therapy (ATT) since 6 months. He presented with headache and severe diminution of vision in the left eye along with field defects in the form of temporal hemianopia in the right eye.

Physical examination was unremarkable. Visual assessment revealed a visual acuity of 6/18 in the right eye and no perception of light in the left eye. Fundus examination showed temporal pallor in the right eye and early optic atrophic changes in the left eye. Automated perimetry revealed absolute temporal field defect in the right eye. MRI of the brain revealed enhancing lesion in the sellar and suprasellar region reported as pituitary macroadenoma, but the shape was suggestive of a meningioma; however, the imaging characteristic was not corroborating with typical meningioma.

The lesion showed conglomerating pattern in one image, and thus a suspicion of tubercular lesion with a background of TBM could not be ruled out. Erythrocyte sedimentation rate (ESR) was raised. His hormone profile was normal, except serum prolactin, which was mildly elevated, 34.21 ng/mL. Serological test for human immunodeficiency virus was negative. Biopsy was planned for the lesion for which the patient was unwilling.

ATT was We intensified and short-term steroid therapy was added as the radiological images was suspicious of tuberculous infection of the pituitary gland. Patient had symptomatic improvement in headache and his visual acuity improved to 6/6 in the right eye and 6/60 in the left eye after 3 months.

A repeat automated perimetry after 3 months revealed significant improvement with absolute upper temporal quadrant field defect in the right eye and absolute upper arcuate defect with lower temporal field defect in the left eye. Repeat MRI of the brain after a total of 12 months of ATT showed no mass lesion in the sellar and suprasellar region. ESR normalized to 10 mm after 1 hour.

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