Tuberculous brain abscess mimicking metastatic disease

Area of Science:

• Neurology
• Infectious Diseases
• Pathology

Background:

• Central nervous system tuberculosis (CNS TB) is a severe infection.
• Tuberculous brain abscesses are rare, often presenting with non-specific symptoms.
• Distinguishing CNS TB from intracranial malignancy can be challenging.

Purpose of the Study:

• To report an unusual case of tuberculous brain abscess.
• To emphasize the importance of considering CNS TB in the differential diagnosis of intracranial masses.
• To illustrate the diagnostic and therapeutic approach.

Main Methods:

• Case presentation of an 85-year-old woman with subacute neurological deficits.
• Neuroimaging findings of multiple rim-enhancing intracranial lesions.
• Diagnostic confirmation via biopsy, histopathology, acid-fast bacilli identification, culture, and molecular testing for Mycobacterium tuberculosis.

Main Results:

• The patient presented with right-sided weakness and dysarthria, initially suspected as metastatic cancer.
• Histopathology revealed a high mycobacterial burden without granuloma formation, confirming tuberculous brain abscess.
• Successful clinical and radiological resolution was achieved after 12 months of anti-tuberculosis therapy.

Conclusions:

• Tuberculous brain abscess can present atypically, closely mimicking intracranial malignancy.
• Early and accurate diagnosis is crucial for effective management.
• Central nervous system tuberculosis should be considered in the differential diagnosis of complex intracranial lesions, even in HIV-seronegative individuals.