Investigations:
Laboratory investigations -
Blood tests (Table - 1): Leukocytosis with neutrophilia, elevated
erythrocyte sedimentation rate (ESR), and elevated C-reactive protein
(CRP).
Interferon-Gamma Release Assay (IGRA): Positive
Cartridge-based Nucleic Acid Amplification Test (CBNAAT): Positive
Cerebrospinal fluid (CSF) analysis: CSF pleocytosis with lymphocytic
predominance, elevated protein, and decreased glucose and also positive
for Acid-fast bacilli. (AFB)
Sputum analysis: AFB smear from sample detected mycobacterium
tuberculosis bacilli.
Radiology investigations -
Brain NCCT (Figure - 1): Revealed a single, ring-enhancing lesion in the
right frontal lobe with surrounding edema (Is encircled in red color in
image) suggestive of brain abscess
Chest X-ray (Figure - 2): Pleural thickening and diffuse calcification
in right lung indicating previous primary tuberculosis infection in this
patient
Pathological and radiological findings suggestive of tubercular brain
abscess. Diagnosis was confirmed with CSF analysis and well established
primary foci of tuberculosis infection in right lung. Management of TBA
is initiated surgically and anti-tuberculosis therapy (ATT) was also
started to resolve infection and prevent recurrence.