Brain tuberculoma in a patient with unsuspected immunocompromise

Abstract

Central nervous system tuberculosis is one of the most severe forms of extrapulmonary tuberculosis, presenting infrequently but with high morbidity and mortality. It is more prevalent in developing countries, and while its occurrence in immunocompetent individuals is rare, there has been a notable increase in cases among those with compromised immune systems. The most common cause of brain abscesses in patients without severe immunosuppression is bacterial infection, typically originating from the oral cavity. In contrast, immunocompromised patients may harbor a wider range of pathogens, including fungi, while bacterial species are more commonly identified in immunocompetent individuals. The organisms isolated from a brain abscess often provide crucial insights into the primary source of infection and may reveal undiagnosed underlying conditions in the patient. We present the case of a 72-year-old male with a medical history of hypertension, dry cough, weight loss, fatigue, and anorexia, who developed dysarthria, confusion, and right-sided facial paralysis. Imaging and serological tests confirmed a diagnosis of brain abscess with perilesional edema. During hospitalization, hematological abnormalities, including persistent leukopenia and hypereosinophilia, prompted further investigation for immunosuppression. A brain biopsy excluded granulomas and neoplasia, while a myelogram revealed myelodysplastic syndrome. The patient showed clinical improvement following empirical antibiotic and antibacterial treatment.

The most common cause of brain abscesses in patients without severe immunosuppression is bacterial infection, typically originating from the oral cavity. In contrast, immunocompromised patients may harbor a wider range of pathogens, including fungi, while bacterial species are more commonly identified in immunocompetent individuals. The organisms isolated from a brain abscess often provide crucial insights into the primary source of infection and may reveal undiagnosed underlying conditions in the patient.

We present the case of a 72-year-old male with a medical history of hypertension, dry cough, weight loss, fatigue, and anorexia, who developed dysarthria, confusion, and right-sided facial paralysis. Imaging and serological tests confirmed a diagnosis of brain abscess with perilesional edema. During hospitalization, hematological abnormalities, including persistent leukopenia and hypereosinophilia, prompted further investigation for immunosuppression. A brain biopsy excluded granulomas and neoplasia, while a myelogram revealed myelodysplastic syndrome. The patient showed clinical improvement following empirical antibiotic and antibacterial treatment.