Abstract

Background: Tubercular cerebral abscess is a rare form of extra-pulmonary TB with incidence rate of 0.3-1.3 cases per million per year in developed countries. Unlike a tuberculoma, which is a granulomatous lesion, a tubercular abscess is characterized by liquefactive necrosis surrounded a well-defined capsule. It’s symptoms depend on the location, size and number of abscess as well as an associated inflammation or edema.This can also mimic other diseases leading to a diagnostic dilemma. In this case report we share our experience on the management of this rare pathology.

Objective: To emphasize the difficulties in distinguishing TB brain abscess from other CNS pathologies, showcase the role of advanced neuroimaging techniques as well as microbiological tests in reaching a definitive diagnosis, raise clinical awareness among clinicians about this rare manifestation of TB observed at BIRDEM General Hospital.

Methods: This report highlights the complexities in diagnosing a 53 year old male with hemiplegia in the setting of post-CABG sepsis, acute kidney injury (AKI) presenting with hypotension and altered level of consciousness. He underwent comprehensive physical and neurological examinations, laboratory investigations ,imaging studies and was treated with modified anti-tubercular regimen.

Common clinical findings: Headache, fever, focal neurological deficits, seizures.

Treatment outcomes: Optimal response was achieved in treating with modified anti-tubercular regimen as well as supportive treatment of underlying diseases.

Conclusion: This case underscores the importance of maintaining a high index of suspicion for tubercular brain abscesses, especially in regions endemic to tuberculosis or in patients with risk factors such as immunosuppression. Early identification, a multidisciplinary approach involving neurology, infectious diseases, and critical care can lead to favourable recovery and minimize long-term neurological sequelae.

Correspondence:

Dr. Monami Khan
MBBS, MRCEM (OSCE,UK)
MO, BIRDEM General Hospital ,Shahbag, Dhaka
Contact: +8801990794276, monaamikhan@gmail.com