Clinical features and differential diagnosis in 18 cases of lepromatous type brain abscess

Abstract

Objective To investigate the clinical features and differential diagnosis of lepromatous type brain abscess. Methods A total of 18 cases with brain abscess admitted to Department of Neurosurgery, Cancer Center, Sun Yat-sen University during October 2000 to February 2007 were retrospectively analyzed with regard to their clinical data and prognosis during follow-up.Results 11 cases had been diagnosed with gliomas and 7 cases had been diagnosed with metastatic tumors in other hospitals. Among the 18 cases, 16 patients took the onset in winter and spring. All of the 18 cases had not found the primary focus of infection. Two cases among them had got a fever 1 month prior to hospitalization. Among the 18 cases, 7 cases had higher total white blood cells (10.1×109/L-13.7×109/L), and 6 cases had higher neutrophil rate (80.8%-90.5%). And the other 11 cases had normal blood routine. After hospitalization, all of the patients received MRI. 14 cases of them were diagnosed with brain abscess, 2 cases with metastatic tumor, 1 case with glioma, and 1 case with parasite. All of the patients got bacterial culture, and showed asepsis in 9 cases, Gram-positive bacteria in 4 cases, streptococci in 3 cases,Staphylococcus epidermidis in 1 case, and Klebsiella pneumoniae in 1 case. Twelve cases underwent resection, and 6 cases received puncture and drainage. During the follow-up ranging 1-6 years, 17 cases healed well, and 1 case get better. Conclusion Lepromatous type brain abscess commonly occurs in winter and spring. The clinical manifestations are untypical. MRI is the most valuable auxiliary examination, and the magnetic resonance spectroscopy and diffusion weighted imaging takes an important role in differential diagnosis between brain abscess and cystic brain tumor with necroses. Key words: Brain abscess; Clinical features; Differential diagnosis