The granulomas are accompanied by many mononuclear inflammatory cells with formation of multinucleated giant cells. No refractile foreign material, pigmented or calcified structures are included in these granulomas. No large or obvious areas of necrosis are seen, either. Judging from the sharp interface with cortical parenchyma, the lesion is mainly on the surface of cerebral hemisphere. In addition to tuberculosis (as many have suggested, and requires demonstration of acid-fast bacilli on stain or culture for a definitive diagnosis), what other differential diagnoses for granulomatous leptomeningitis should be considered?
The granulomas are accompanied by many mononuclear inflammatory cells with formation of multinucleated giant cells. No refractile foreign material, pigmented or calcified structures are included in these granulomas. No large or obvious areas of necrosis are seen, either. Judging from the sharp interface with cortical parenchyma, the lesion is mainly on the surface of cerebral hemisphere. In addition to tuberculosis (as many have suggested, and requires demonstration of acid-fast bacilli on stain or culture for a definitive diagnosis), what other differential diagnoses for granulomatous leptomeningitis should be considered?