Kaustav Ghosh, Prakas Kumar Mandal
Patients with acute leukemia are immunocompromised and highly susceptible to infections. Central nervous system (CNS) tuberculoma is a rare but serious complication in this population, particularly among those undergoing treatment for hematological malignancies. Early diagnosis is often challenging due to non-specific symptoms. We report the case of a 28-year-old female recently diagnosed with CALLA-positive B-cell acute lymphoblastic leukemia, who presented with a two-month history of low-grade fever. Induction chemotherapy was initiated; however, during the third week, she developed new-onset seizures. A computed tomography scan of the brain revealed a heterogeneous ring-enhancing lesion in the right parietal lobe. Magnetic resonance imaging with spectroscopy demonstrated characteristic lipid peaks, supporting the diagnosis of a tuberculoma. Antitubercular therapy comprising rifampicin, isoniazid, pyrazinamide, and ethambutol, along with pyridoxine and dexamethasone, was commenced. The patient showed a favorable response, with resolution of fever and no recurrence of seizures. This case underscores the importance of considering CNS tuberculosis in the differential diagnosis of unexplained neurological symptoms and fever in patients with acute leukemia, particularly in tuberculosis-endemic regions. Prompt recognition and treatment can lead to favorable outcomes.