Purpose or Case Report: Tumefactive white matter lesions in pediatric patients represent a significant diagnostic challenge, as their size, mass effect, and contrast enhancement on MRI can closely mimic neoplastic processes. However, they often reflect inflammatory, autoimmune, or demyelinating etiologies rather than true tumors. Early recognition is crucial to avoid unnecessary invasive procedures and to initiate timely immunomodulatory treatment.

We present two pediatric patients with acute neurological symptoms and multifocal tumor-like white matter lesions. The first patient, a 17-year-old male, presented with left-sided hemiparesis and multiple lesions involving both cerebral hemispheres. The second patient, a 15-year-old female, presented with acute visual loss and multifocal lesions within the occipital and parietal white matter. Both patients were treated with high-dose corticosteroids and supportive therapy. The second patient additionally received intravenous immunoglobulins and empiric antimicrobial therapy due to initial diagnostic uncertainty. Partial regression of the lesions and clinical improvement were observed in both cases.

Tumefactive-like lesions in pediatric patients can closely mimic neoplasms but often show a favorable response to immunomodulatory therapy. Early recognition, multidisciplinary assessment, and close follow-up are essential to optimize clinical outcomes.
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