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 male. 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/microL, and three had a CD4+ cell count lower than 100 cells/microl. 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.


CONCLUSIONS
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.
Vidal
J E
JE
Department of Infectious Disease, Institute of Infectious Disease Emilio Ribas, Sao Paulo, Brazil. jbermudez@emilioribas.sp.gov.br
Penalva de Oliveira
A C
AC
Bonasser Filho
F
F
Schiavon Nogueira
R
R
Dauar
R F
RF
Leite
A G
AG
Lins
D L M
DL
Coelho
J F G S
JF
D017088:AIDS-Related Opportunistic Infections / Q000473:pathology; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001922:Brain Abscess / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D020306:Tuberculosis, Central Nervous System / Q000209:etiology* / Q000473:pathology / Q000601:surgery
D000995:Antitubercular Agents