Young adult treated for brain TB for years, but doctors later discover rare worm infection

For a young man in his late 20s, the last five years had been marked by repeated seizures and growing uncertainty. What first appeared to be a small lesion in the brain was believed to be tuberculosis, a more commonly suspected condition when such lesions are seen on MRI. With that diagnosis, he underwent anti-tubercular treatment for 18 months, hoping that the lesion would shrink and his symptoms would improve.

However, instead of responding to treatment, the lesion continued to increase in size. His seizures persisted, his symptoms worsened, and the concern for both him and his family only grew with time. What made the situation more difficult was that the brain lesion was not behaving the way tuberculosis usually would after prolonged treatment. This raised an important question for the treating team: was this really brain tuberculosis, or was a rare condition being missed?
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As the lesion continued to grow despite medical therapy, doctors at Apollo Hospitals, Sheshadripuram, decided that surgery was necessary, both to treat the lesion and to reach a definite diagnosis. Since the lesion was inside the brain, precision was extremely important. The neurosurgical team used advanced neuro-navigation technology to accurately locate the abnormal area, minimise the size of the craniotomy, and reduce surgical risk.
The final answer came through histopathological examination of the excised lesion. It was not tuberculosis. The lesion was confirmed to be intracranial sparganosis, a rare parasitic worm infection involving the brain.

Following the diagnosis, the patient was started on appropriate anti-helminthic therapy and is recovering well.
“When a brain lesion continues to enlarge despite adequate treatment, it becomes important to reconsider the diagnosis. In this case, surgery was planned not only to remove the lesion safely but also to obtain tissue confirmation, which was crucial for identifying the exact cause,” said Dr. Adesh J, Senior Consultant, Neurosurgery & Spine Surgery, Apollo Hospitals, Sheshadripuram.

The surgery was completed successfully. The patient was conscious soon after the procedure, started oral intake on the same day, and was able to walk on the first postoperative day. His recovery was smooth enough for him to be discharged within 48 hours, bringing relief to the patient and his family after years of uncertainty.

“Sparganosis of the brain is extremely rare and can mimic more common conditions such as tuberculosis on imaging. This case highlights why tissue diagnosis becomes important when a lesion does not respond as expected. Neuro-navigation helped us localise the lesion accurately, minimise surgical morbidity, and support faster recovery,” said Dr. Raj Kumar Pannem, Consultant, Neurosurgery, Apollo Hospitals, Sheshadripuram.

The case highlights the importance of considering rare causes when a presumed diagnosis does not follow the expected course.

Today, after years of seizures and uncertainty, he is recovering well, with doctors continuing to monitor his progress as part of his treatment journey.