12 brain lesions—but it wasn't cancer: A neurosurgeon’s unforgettable case
Key Takeaways
Vital Signs
Male
49 years old
Presents with dizziness and headaches
Contrast MRI of the brain administered
12 masses visualized
No matter how many years you’re in the field, you’ve never quite “seen it all.” Rupa Juthani, MD, board-certified neurosurgeon and brain tumor specialist, found that out after a curious case took her by surprise. What she thought was advanced disease was something much rarer.
“This is one of the most unusual cases I have ever seen,” says the doctor at the start of an Instagram video.
The Patient
A 49-year-old man, presented with fairly routine complaints: dizziness, slight weakness, and a headache. His symptoms were mild, explains Dr. Juthani.
The Initial Tests
The patient underwent a brain scan — an MRI with contrast enhancement — which showed multiple white areas, thought to be masses or tumors. In fact, 12 areas were pinpointed in total.
The Suspected Diagnosis
The size, appearance, and number of these masses, which were widely dispersed throughout the brain, had everyone thinking the patient most certainly had metastatic cancer, or advanced cancer that had spread to his brain.
Related: What if your hospital gave you a brain tumor?The Truth
What they were really seeing was far stranger.
The medical team removed one of the masses to make a more accurate diagnosis, selecting it based on safety and size, as well as for therapeutic benefit to reduce swelling in this area.
“What we found surprised all of us,” said the seasoned neurosurgeon. Surgeons saw a necrotizing granuloma, or a ball of inflammation in the brain, as she described in her caption.
Doctors sent the tissue for sampling, and pathology delivered a curveball: It wasn’t cancer at all. It was tuberculosis in the brain.
"In very rare cases, about 1–2% of the time, [this bacterial infection] can spread to the brain,” said Dr. Juthani in the video. “And when it does, it usually causes meningitis. Causing all of these tumors is extremely rare."
The Treatment
This kind of presentation and imaging could easily prompt even the best physicians to suggest unnecessary treatment.
Related: The biggest TB crisis since the 1950s vs a federal health communications freeze: What’s the worst we can expect?Instead of being treated for metastatic cancer, the patient can simply take oral antibiotics and make a full recovery, she explains.
Your Takeaway
This extremely rare case serves as a humbling reminder for physicians to avoid assumptions and always dig deeper — even when you think you’re certain about a diagnosis.
“In this case, I loved being surprised,” said Dr. Juthani.
