Tuberculous brain abscess mimicking a neoplastic lesion in a patient with well-controlled human immunodeficiency virus infection: illustrative case.

Authors

Daniel J Valdivia, Henry Noren, Brennan Cook, Yaxel Levin-Carrion, Elizabeth E Ginalis, Peter-Okaka Uchenna, Misha Movahed-Ezazi, Sarag Boukhar, Ada Baisre, Srihari Sundararajan, Hai Sun

Published in

Journal of neurosurgery. Case lessons. Volume 12. Issue 4. Jul 27, 2026. Epub Jul 27, 2026.

Abstract

Tuberculous brain abscess is a rare manifestation of CNS tuberculosis, typically occurring in patients with significant immunosuppression. These lesions may present as solitary ring-enhancing masses and can radiographically resemble neoplastic processes, creating diagnostic and management challenges.
A 43-year-old man with well-controlled human immunodeficiency virus (HIV) infection and a remote history of treated pulmonary tuberculosis presented with progressively worsening unilateral headaches. MRI demonstrated a small, lobulated, peripherally enhancing posterior temporal lobe mass adjacent to dominant-hemisphere language cortex without surrounding edema, raising concern for a neoplastic lesion. Given the progressive symptoms and eloquent location, the patient underwent awake craniotomy with language mapping and gross-total resection. Histopathological evaluation revealed a chronic abscess with granulomatous inflammation, and acid-fast staining and polymerase chain reaction confirmed Mycobacterium tuberculosis, establishing the diagnosis of tuberculous brain abscess. The patient recovered without new neurological deficits and showed clinical improvement at follow-up.
Tuberculous brain abscess can occur even in patients without overt immunodeficiency, including those with well-controlled HIV infection. Because imaging findings may overlap with neoplastic lesions and systemic infectious features may be absent, maintaining a broad differential diagnosis and pursuing timely tissue confirmation are essential to guide appropriate management and avoid delays in treating either infection or malignancy. https://thejns.org/doi/10.3171/CASE26178.

PMID:
42508059
Bibliographic data and abstract were imported from PubMed on 28 Jul 2026.

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