Tuberculous brain abscess in AIDS patients: report of three cases and literature review

Objective: Clinical description of tuberculous brain abscess in patients with acquired immunodeficiency syndrome (AIDS). Methods: Clinical case report and review of the literature from January 1981 to January 2003 using the MEDLINE database. Results: The authors report three cases of tuberculous brain abscess in AIDS patients and review nine similar cases. The mean age was 30 years (range: 18-56 years) with seven patients being mate. Five (42%) were intravenous drug users, had prior history of extra-cerebral tuberculosis, and presented alterations on chest radiograph. Tuberculin skin test was anergic in six (75%) of eight patients. Three patients of nine had a CD4(+) cell count higher than 200 cells/mu L, and three had a CD4(+) cell count lower than 100 cells/mu l. All but one patient had a brain Computerized tomography scan with a single lesion. All patients received anti-tuberculous treatment and underwent surgical procedures. Most patients (75%) showed appropriate clinical responses. Conclusion: Tuberculous brain abscess must be considered in the differential diagnosis of intracranial mass in AIDS patients. A careful epidemiological, clinical and laboratory evaluation may guide a diagnostic suspicion. Surgery combined with specific anti-tuberculosis treatment seems to determine a good outcome. (c) 2005 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.