Tuberculous Brain Abscess: Rare presentation of a common disease

Saumya Jakati; Swetha Narla; Megha S Uppin; M Vijaya Saradhi; B P Sahu; A K Purohit; V Lakshmi; C Sundaram

Volume : VIII, Issue : VI, June - 2018

Tuberculous Brain Abscess: Rare presentation of a common disease

Saumya Jakati, Swetha Narla, Megha S Uppin, M Vijaya Saradhi, B P Sahu, A K Purohit, V Lakshmi, C Sundaram

Abstract :

Introduction: Tuberculous ain abscess is a rare form of central nervous system tuberculosis. It needs to be differentiated from pyogenic ain abscess which is a close mimic on radiology and histopathology. Material and methods: Retrospective review of case records of histologically confirmed ain abscess and tuberculomas from 1987 to 2014 was done and cases fulfilling the criteria by Whitener were included. The clinical, imageologic, histologic and microbiologic findings were noted. ZeihlNeelson (ZN) stain and additional stains as appropriate were performed. Results: There were 8 patients with TBA accounting for 2.67% of ain abscess and 2.88% of tuberculomas in the study period (28 years). There were 5 males and 3 females in the age range 10–45 (median 26.5) years. CT scan showed ring enhancing lesions with central hypodensity in all of them. The histopathology showed granulation tissue with palisading histiocytes and necrotic material with tinctorial properties of caseation. ZN stain revealed acid fast bacilli which were further confirmed on culture examination. The unusual findings were atypical mycobacteria in one and concomitant Nocardiaspp in another. Conclusion: Histopathology with appropriate additional stains and culture confirmation help in identifying concomitant pathogens. Correct diagnosis and differentiation from pyogenic abscess is essential for management.