Cerebellar Multiloculated Abscess and Multiloculated Intraventricular Abscess in Extrapulmonary TB

Rarity of Tuberculous Brain Abscess

Genitourinary TB represented only 4.6% of extrapulmonary TB cases in the European Union between 1997 and 2017, indicating that tuberculous brain abscess (TBA) is even less common 1

Multiloculated lesions are recognized as a distinct risk factor for abscess rupture, which carries case-fatality rates of 27-50% 2, 3

The European Society of Clinical Microbiology and Infectious Diseases recommends sending pus samples for Ziehl-Neelsen stain, culture, and PCR for tuberculosis in endemic areas or based on clinical presentation 3
The American College of Radiology recommends brain MRI with diffusion-weighted imaging and gadolinium enhancement as the preferred imaging modality 4

The Infectious Diseases Society of America recommends antituberculous therapy as the mainstay of management, with 6-9 months of standard treatment recommended, although the exact duration may vary depending on the specific case 4

Tuberculous brain abscess (TBA) occurs more frequently in developing countries and areas endemic for tuberculosis, where Mycobacterium tuberculosis remains an important causative pathogen of brain abscess 5

In endemic areas, TBA is a significant concern, with Mycobacterium tuberculosis being a common cause of brain abscess, and Nocardia species, fungi, and parasites being more common causes of brain abscess in severely immunocompromised patients, rather than tuberculosis 5

The American College of Neurology suggests that brain abscesses located near the ventricles, especially multiloculated ones, are more frequently associated with ventriculitis due to their risk of intraventricular rupture, with mortality rates ranging from 27-50% 6

The Infectious Diseases Society of America indicates that ventriculitis occurs mainly when a brain abscess ruptures into the ventricular system, causing fulminant meningitis, with rupture potentially occurring into the subarachnoid space or ventricles 6
The reported incidence of brain abscess rupture varies from 10% to 35%, with approximately half diagnosed immediately upon admission, according to the Clinical Microbiology and Infection guidelines 6

The European Society of Clinical Microbiology and Infectious Diseases states that abscesses with a higher risk of causing ventriculitis have characteristics such as proximity to the ventricles, which is a primary risk factor for rupture 6
Multiloculated abscesses have a significantly increased risk of rupture, as noted by the Clinical Microbiology and Infection society 6

The World Health Organization warns that the rupture of abscesses into the ventricles often requires external ventricular drainage for obstructive hydrocephalus, with a mortality rate of 30.6% and 38.8% at one year 6