Abstract
Tuberculosis (TB) is one of leading causes of death, especially in
developing countries. Common manifestations of TB include pulmonary
symptoms with fever like, cough and pleuritic chest pain. Tubercular
meningitis or tubercular brain abscess (TBA) is one of the rare
manifestations of tuberculosis which leads to marked morbidity and
mortality in TB patients. Prevalence of TBA is approximately 4-8% in
immunocompetent individual however, in individual with pre-existing
immunocompromised state like, HIV seropositive individual occurrence of
TBA is shoots up to 20%. Here, we reported a case of 45-year-old male
patient on anti-retroviral therapy (ART) with known status of HIV
positive, presented with headache, fever and vomiting since several
days. On admission, lab investigations revealed, mild leukocytosis with
raised ESR and CRP. Non-contrast computed tomography (NCCT) of brain
shows single ring enhancing lesion mimicking brain abscess. Further
investigations confirmed tuberculosis infection. CSF analysis also
suggestive of tubercular meningitis. Stereotactic aspiration of abscess
was done with in situ catheter for drain residual fluid. Along with
surgical management, anti-tubercular therapy (ATT) was also initiated in
patient to control tubercular infection and prevent recurrence. Due to
extensive treatment with ATT, ZN stain become negative and CXR return
partially to normal state without any residual clinical symptoms and
focal neurological deficit.