Intraventricular tuberculosis abscess in an immunocompromised patient: clinical vignette

Area of Science:

• Neurology
• Infectious Diseases
• Radiology

Background:

• Tuberculosis (TB) commonly affects the central nervous system (CNS), presenting as meningitis or intraparenchymal lesions.
• Intraventricular tuberculous abscess is an exceptionally rare manifestation of neurotuberculosis.

Purpose of the Study:

• To report a rare case of intraventricular tuberculous abscess in an immunocompromised patient.
• To emphasize the diagnostic challenges and importance of early recognition of rare neurotuberculosis presentations.

Main Methods:

• Case presentation of an immunocompromised female with fever and meningism.
• Brain imaging with computed tomography (CT) and magnetic resonance imaging (MRI) to identify hydrocephalus and a rim-enhancing lesion.
• Diagnostic confirmation using polymerase chain reaction (PCR) and culture analysis of drained pus.

Main Results:

• MRI revealed hydrocephalus and a lesion in the right lateral ventricle with characteristic imaging findings (T1 hypointensity, T2 hyperintensity, restricted diffusion).
• Emergency external ventricular drainage yielded frank pus.
• PCR and culture confirmed Mycobacterium tuberculosis as the causative agent.

Conclusions:

• Intraventricular tuberculous abscess is a rare but critical diagnosis within neurotuberculosis.
• Prompt recognition and management, including surgical intervention and antimicrobial therapy, are crucial for favorable outcomes in immunocompromised individuals.