Abstract

Background: Tuberculosis is one of the common infectious diseases affecting the brain mainly affecting the cerebellum and brainstem. However when such lesions involve the frontal lobe, it causes changes in personality and behaviour. These changes may be the core presenting feature of such diseases sometimes, thus delaying the diagnosis of cerebral mass lesions.

Method: This is an observational case report

Case Discussion: A 43 year old female presented to with features of severe depression such as sadness of mood, easy fatigability,  anhedonia, decreased sleep with suicidal tendencies, with symptoms of weight loss, fever, decreased appetite, headache and left hemifacial spasms without any contributory personal or family history. No apparent stressors reported. Magnetic Resonance imaging with spectroscopy was done which was suggestive of tuberculoma involving bilateral frontal lobes.

Conclusion: To our knowledge, this is the rare case reported with a diagnosis of frontal lobe tuberculoma masquerading as severe depression. This case presenting with primary psychiatric symptoms with coexisting features of headache, fever, decreased appetite, decreased sleep, weight loss and intermittent left hemifacial spasms was found to have bilateral frontal lobe tuberculoma, thus demonstrating the importance of evaluation for organic etiology in patients who present with psychiatric symptoms masking central nervous system pathology.

Keywords: Depression, frontal lobe tuberculoma, organic etiology.