[Tuberculous brain abscess. A case report (author's transl)].

Abstract

A case of tuberculous brain abscess diagnosed from the macroscopic, histological and bacteriological aspects is presented. A 39-year-old man was initially admitted to a sanatorium in June, 1977 for the treatment of lung tuberculosis with associated diabetes mellitus. He developed fever, headache and convulsion in April, 1978. Brain CT scan revealed a mass in the cerebrum. Neurological examination demonstrated mental confusion with memory disturbance and disorientation with urinary and fecal incontinence. He had mild right hemiparesis with a positive Babinski sign. There was no meningeal sign. Repeated brain CT scans showed a low density area surrounded by enhanced ring blush in the left frontal lobe and displacement of left lateral ventricle to the right. A presumtive diagnosis of tuberculous brain abscess was made. External drainage yielded 60 ml of purulent material. Acid-fast bacillus stains of the puss were positive and the culture proved M. tuberculosis. A left frontotemporal craniotomy was then performed and the abscess was excised en bloc. Histological examination of the capsule wall demonstrated an internal necrotic zone with polymorphnuclear leukocytes. The necrotic area was surrounded by granular reaction, rich in epitheloid cells, some of which showed giant cells of the Langhans type. Outside this zone, there was a fibrous tissue wall with a large number of immature vessels and collection of mononuclear cells. Postoperative recovery was uneventful. At the time of discharge, he showed no evidence of any neurological defects. Tuberculous brain abscess have rarely been reported unlike the more common tuberculoma, even before the introduction of antituberculous chemotheraphy. Diagnostic criteria of tuberculous brain abscess should be based only on macroscopic and bacteriological aspects.