Posterior fossa tuberculosis: Unusual presentations of a common disease and literature review

The burden of tuberculosis is very high in our country and though the number of deaths due to tuberculosis has drastically reduced, still the associated morbidities caused by the disease can be very debilitating.1 Central nervous system tuberculosis is a rare and serious presentation of tuberculosis, the general presentation being hydrocephalus, meningitis, and disseminated miliary lesions.2 More often than not tuberculosis is associated with immunocompromised status and central nervous system tuberculosis in immunocompetent young individuals with no evidence of systemic tuberculosis is very rare.3Association of tuberculosis with ocular manifestations and even blindness is not uncommon, the causes of blindness being causes like uveitis, retinitis, interstitial keratitis, ophthalmitis, and even orbital tuberculosis.4 Classical teaching in neurosurgery is that a posterior fossa lesion unless proven otherwise is a metastasis. Therefore, here we are discussing three cases of central nervous system tuberculosis in isolation, without any systemic involvement in immunocompetent adults in the posterior fossa region as well as a literature review of cases from across the globe of posterior fossa tuberculosis in immunocompetent adults. The first case is regarding a treatable cause like tuberculoma in an immunocompetent young adult causing blindness which is rare as well as unfortunate. The other two cases highlight the need to keep tuberculosis as a differential even when the clinical features, radiological features, and blood and other investigations are not suggestive.