A 38-year-old immunocompetent woman presented with complaints of hemicranial headache and painful ophthalmoplegia, both of which had been persistent and progressive for two years. Fever and other symptoms were not observed. She had a history of tuberculous lymphadenitis that was successfully treated 20 years ago. Contrast-enhanced axial T1-weighted magnetic resonance imaging (MRI) of the brain revealed contrast-enhanced meningeal thickening in the upper left (Figure 1A, white arrow) and left cerebellar hemispheres. Meningioma was the main diagnosis as an investigation of the cerebrospinal fluid returned negative results for the GeneXpert test. However, a histopathological diagnosis of tuberculosis (TB) was made on the basis of a biopsy (Figure 2). Therefore, the patient was initiated on presumptive antituberculosis treatment for 12 months. Further, late MRI demonstrated a radiological improvement in the meningeal thickening (Figure 1B, white arrow).
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