Tuberculous Brain Abscesses in Immunocompetent Patients: Management and Outcome

Cárdenas, Graciela; Soto-Hernández, José Luís; Orozco, Rosalba Vega; Silva, Erik Guevara; Revuelta, Rogelio; Amador, Juan Luis Gómez

doi:10.1227/neu.0b013e3181eda396

Cited by 25 publications

(15 citation statements)

References 25 publications

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“…They also described the use of in vitro proton magnetic resonance (MR) spectroscopy as a diagnostic modality for TBA. In another case series Cárdenas et al [ 12 ] described six patients with TBA who were immunocompetent. All the patients on presentation had intracranial hypertension and focal neurological signs and symptoms on presentation.…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Central Nervous System Tuberculosis

Parekh

Haftka

Porter

2014

Case Reports in Infectious Diseases

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Intracranial abscess is an extremely rare form of central nervous system (CNS) tuberculosis (TB). We describe a case of central nervous system tuberculous abscess in absence of human immunodeficiency virus (HIV) infection. A 82-year-old Middle Eastern male from Yemen was initially brought to the emergency room due to altered mental status and acute renal failure. Cross-sectional imaging revealed multiple ring enhancing lesions located in the left cerebellum and in bilateral frontal lobe as well as in the inferior parietal lobe on the left. The patient was placed on an empiric antibiotic regimen. Preliminary testing for infectious causes was negative. Chest radiography and CT of chest showed no positive findings. He was not on any immunosuppressive medications and human immunodeficiency virus (HIV) enzyme immunoassay (EIA) test was negative. A subsequent MRI one month later showed profound worsening of the lesions with increasing vasogenic edema and newly found mass effect impinging on the fourth ventricle. Brain biopsy showed focal exudative cerebellitis and inflamed granulation tissue consistent with formation of abscesses. The diagnosis of CNS TB was finally confirmed by positive acid-fast bacilli (AFB) cultures. The patient was started on standard tuberculosis therapy but expired due to renal failure and cardiac arrest.

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Section: Discussionmentioning

confidence: 99%

A Rare Case of Central Nervous System Tuberculosis

Parekh

Haftka

Porter

2014

Case Reports in Infectious Diseases

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“…15 It is associated with a high mortality rate and severe neurological sequelae and includes three clinicopathological forms: meningoencephalitis, tuberculomas and abscesses. 15 Clinically, meningitis presents most commonly as headache, nuchal rigidity, fever and vomiting. Less common findings are altered mental status, cranial nerve palsy and other focal neurologic signs.…”

Section: Discussionmentioning

confidence: 99%

Tuberculous Spondylitis Presenting as Severe Chest Pain

Kaeser

Kettner

Albastaki

et al. 2012

Clinics and Practice

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This case report describes a 32-year-old male who presented to an emergency department with severe chest pain and a history of cough, fever, night sweats, loss of appetite and weight. Chest radiography revealed a left upper lobe consolidation and multiple compression deformities in the thoracic spine. Magnetic resonance imaging demonstrated significant kyphosis and vertebral plana at two thoracic levels. Anterior compression of the spinal cord and adjacent soft tissue masses were also noted.

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“…[23] It occurs in only 4 to 8% of patients with CNS TB who do not have HIV infection [1] but in 20% of patients who do have HIV infection. [24,25] We encountered one such case which yielded a pure growth of M. tuberculosis. Fischl et al [21] described a case of TBA and toxoplasma encephalitis in a Haitian woman with AIDS.…”

Section: Discussionmentioning

confidence: 99%

Tuberculous brain abscesses: Case series and review of literature

Menon

Bharadwaj

Chowdhary

et al. 2011

Journal of Neurosciences in Rural Practice

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Introduction:Tuberculous brain abscess (TBA) is a rare but serious condition. It resembles a pyogenic brain abscess clinically and radiologically and poses a problem in diagnosis and treatment. A final diagnosis is established by smear or culture demonstration of acid fast bacilli (AFB) within the abscess. Here, we report four such cases in our five-year study on brain abscesses, along with the different diagnostic modalities used.Materials and Methods:A total of 75 brain abscess pus specimens were collected during neurosurgery, either by burr hole or by craniotomy. These specimens were further subjected to Gram stain, Ziehl-Neelsen (ZN) stain, and conventional microbiological culture. Only those cases which showed presence of AFB on ZN stain along with the growth of Mycobacterium tuberculosis were considered as TBAs. Such TBA cases were further presented along with their In vitro Proton Magnetic Resonance (MR) Spectroscopic findings.Results:Of these four patients, three were males. Though this condition is more commonly seen in immunocompromised patients, three of the patients in this study were immunocompetent. All the four pus specimens showed presence of AFB in the ZN stain. Three of them grew M. tuberculosis as sole isolate. The fourth case was of concomitant tuberculous and pyogenic brain abscess. In vitro Proton MR spectroscopy of the pus specimens showed absence of multiple amino acids at 0.9 ppm, which was found to be hallmark of TBA. One patient died of four.Conclusions:TBA always poses a diagnostic dilemma. ZN stain and conventional microbiological culture for Mycobacteria always help to solve this dilemma. In vitro Proton MR Spectroscopy also seems to have the diagnostic utility.

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Tuberculous Brain Abscesses in Immunocompetent Patients: Management and Outcome

Cited by 25 publications

References 25 publications

A Rare Case of Central Nervous System Tuberculosis

A Rare Case of Central Nervous System Tuberculosis

Tuberculous Spondylitis Presenting as Severe Chest Pain

Tuberculous brain abscesses: Case series and review of literature

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