Tuberculous brain abscess in a patient with AIDS: case report and literature review

Abstract

SUMMARYTuberculous brain abscesses in AIDS patients are considered rare with only eight cases reported in the literature. We describe the case of a 34-year-old woman with AIDS and previous toxoplasmic encephalitis who was admitted due to headache and seizures. A brain computed tomography scan disclosed a frontal hypodense lesion with a contrast ring enhancement. Brain abscess was suspected and she underwent a lesion puncture through a trepanation. The material extracted was purulent and the acid-fast smear was markedly positive. Timely medical and surgical approaches allowed a good outcome. Tuberculous abscesses should be considered in the differential diagnosis of focal brain lesions in AIDS patients. Surgical excision or stereotactic aspiration, and antituberculous treatment are the mainstay in the management of these uncommon lesions.

Chagasic meningoencephalitis: case report of a recently included AIDS-defining illness in Brazil

“…In certain circumstances, a surgical approach must be precipitated, such as in patients with negative IgG serology for T. gondii and single brain lesion, or when indicated at the therapeutic level 2 . However, high levels of suspicion of alternative cerebral toxoplasmosis diagnoses, as has been already reported in one case of cytomegaloviruses 5 and in another of brain tuberculous abscess 29 , could also indicate the need for early biopsy. Interestingly, MONTERO et al 22 proposed a diagnostic algorithm for focal brain lesions in Chagas disease endemic areas.…”

Neurotuberculosis and HIV Infection

“…Cerebral localisations are more frequent than spinal ones. Data on HIV patients presenting tuberculomas is scarce [95,96]. The diagnosis is probably underestimated in low income countries taking into account the expensive CT/MRI importance in the confirmation.…”

Cerebral tuberculomas in AIDS patients: a forgotten diagnosis?

“…This is possible due to the fact that the number of CNS TB cases in developed countries is very limited, as demonstrated in a detailed neuropathological study 8 . In the AIDS era, Lesprit et al 9 found only 21 cases of cerebral TB (including tuberculomas and abscesses), and Vidal et al 10 found nine cases of tuberculous abscess. The lack of reports of CNS TB in developing countries, where the TB prevalence is high, can be due to underdiagnosis and underregister of cases and, indeed, to the lack of publications.…”

“…On the other hand, abscess require to fulfill the following criteria: (1) macroscopic evidence of pus, (2) inflammatory reaction in the abscess wall, which consists of granulate vascular tissue and acute and chronic inflammatory cells, and (3) demonstration of AFB in the purulent material or in the abscess wall, or positive culture of M. tuberculosis. Definitive diagnosis of cerebral tuberculoma needs histopathologic evidence in the cerebral tis- The clinical presentation of tuberculomas and tuberculous abscesses is similar to the main CNS expansive lesions in AIDS patients 9,10 . However, the tuberculous abscesses usually have a more accelerated clinical course.…”

“…Arq Neuropsiquiatr 2004;62 (3-B) In contrast to the cerebral TB abscesses, which require surgical and pharmacological treatment 10,12,14 , tuberculomas generally respond quite well with only pharmacological treatment 16,17 . Nevertheless, like was verified in some of our patients, the differentiation between this two diagnoses is difficult and complicates the surgical decision.…”