Tuberculous brain abscess: A case report with a review of the literature in English

Abstract

A 69‐year‐old man had a tuberculous brain abscess in the right frontal lobe as well as an underlying alcoholic cirrhosis of the liver. The abscess responded well to combined surgical excision and antituberculous treatment. A review of 42 patients, including this patient who had tuberculous abscesses of the central nervous system (CNS) disclosed 54% of classical (genuine, true or typical) lesions morphologically similar to the pyogenic abscess, and 46% of atypical lesions having granulomatous changes without caseous necrosis in the abscess wall. The size of the abscesses ranged from 2 mm to 5 cm across. Some abscesses contained 3–60 mL of pus. Most tuberculous abscesses resulted from hematogenous dissemination of tubercle bacilli from primary tuberculous foci outside the CNS; a few were probably related to direct extension of tuberculosis of the ear. Approximately 58% of patients were aged in the first three decades of life and 22% of patients were children of less than 15 years of age. The mean age was 31 years for both genders. The sexual ratio was 7:6 for males and females. The frontal lobe and cerebellum were the common sites of occurrence. Approximately 19% of patients with CNS tuberculous abscesses were associated with the acquired immunodeficiency syndrome (AIDS). Combined surgical extirpation and antituberculous drugs were the treatment of choice. Needle aspiration combined with appropriate antituberculous drugs have yielded satisfactory results in some patients. An intra‐operative smear and a stain of pus for acid‐fast bacilli is necessary for rapidly distinguishing between a tuberculous abscess and a pyogenic abscess as well as for proper immediate postoperative treatment. Geographically, the CNS tuberculous abscesses were scattered in many countries, particularly in India and the USA. Their increased incidence is expected in relation to the present prevalence of AIDS.