Tuberculous brain abscess in a child with cystic fibrosis; a case report

ABSTRACT

Tuberculous brain abscess is an extremely rare manifestation of tuberculous involvement of the central nervous system. In countries such as India where tuberculosis is fairly common, few cases of tuberculous brain abscess have been reported. The patient was an 8-year old boy presented with the diagnosis of cystic fibrosis and a history of tonic and clonic convulsions since 2 years ago with normal brain CT scan. Two months ago he became febrile and complained of severe headache that often awakened him up. Diagnosis of intracranial abscess was made clinically and the patient received ceftriaxon, amikacin and clindamycine; however, 2 weeks of treatment failed to show improvement. During craniotomy multiple cystic lesions and a mass of 9x3x8cm in frontoparietal area was found. After operation the patient developed severe hepatitis with elevated enzymes and bilirubin level due to anesthesia and anti- tuberculous treatment. Drugs were discontinued but fever persisted and he started a downhill course. While hepatitis was going to resolve, restarting antituberculous drugs flared up hepatitis and 3 days later he expired because of hepatic failure. Meningitis is an entity of tuberculous infection in subjects living in countries of high burden tuberculosis, thus, it should be kept in mind for suspicious subjects: