PMC6188763_01
Sagittal, coronal, and transverse sections showing diffused dural thickening with contrast enhancement.
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fig1
We performed a new MRI scan of the brain with contrast, which revealed a diffuse and patchy meningeal thickening and enhancement mainly in the right frontoparietal and left occipital regions with a minor enhancement of bilateral optic sheaths (Figure 1).
(a) Large areas with caseous necrosis (H&E x 40). (b) Arrow on the left:areas of caseous necrosis; eosinophilic, granular, and amorphous material with scattered nuclear debri (H&E x 400); arrow on the right:epithelioid histiocytes lining the areas with caseous necrosis (H&E x 400).
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fig2
Therefore, she underwent a dural biopsy from the thickened dura, which revealed large areas of caseous necrosis surrounded by epithelioid histiocytes and lymphoid cells with a few isolated giant cells in the adjacent vicinity (Figure 2).
Positive Mantoux test of 25 mm.
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fig3
This diagnosis was presumed by the presence of necrotizing granulomatous necrosis with caseation with a strongly positive Mantoux test of 25 mm (Figure 3), and later was supported by a marked response to antituberculous medication.