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.