Tuberculoma of the Peripheral Nerve: Illustrative Case and Systematic Review of the Literature

BACKGROUND: Tuberculomas affecting the peripheral nerve are exceedingly rare. As such, little has been reported about their clinical features, treatment, and outcomes. METHODS: We report the case of a 10-year-old male patient with histopathologically proven tuberculoma presenting preoperatively as a peripheral nerve tumor. We also performed a systematic review of the SCOPUS and PubMed databases for case reports and case series documenting patients with histopathologically confirmed peripheral nerve tuberculoma and discussed clinical features and treatment outcomes. RESULTS: A total of 7 cases of peripheral nerve tuberculomas were reported in the literature, including the current case. The mean age was 21.4 years with no sex predilection. The ulnar nerve was involved in all cases. The most common clinical manifestations were hand weakness, atrophy, ulnar clawing, and hypoesthesia. The classic histopathologic features of caseous necrosis, epithelioid granulomas, and Langhans giant cells were seen in all cases, while staining for acid fast bacilli was positive in only one case. All patients underwent nerve exploration and lesion resection, and were given antitubercular treatment lasting between 3 and 18 months. Treatment resulted in complete recovery in 43% of cases and partial improvement of neurologic deficits in 57%. CONCLUSIONS: Tuberculoma of the peripheral nerve is a rare manifestation of tuberculous disease, with a predilection for the ulnar nerve. Current management includes nerve exploration, lesion resection, and antitubercular treatment, which often results in good neurologic recovery.