Vidal José E, Cimerman Sérgio, da Silva Paula R Marques, Sztajnbok Jaques, Coelho João F G S, Lins Diogo L M
Instituto de Infectologia Emílio Ribas, São Paulo, SP, Brazil.
Rev Inst Med Trop Sao Paulo. 2003 Mar-Apr;45(2):111-4. doi: 10.1590/s0036-46652003000200013. Epub 2003 May 14.
Tuberculous brain abscesses in AIDS patients are considered rare with only eight cases reported in the literature. We describe the case of a 34-year-old woman with AIDS and previous toxoplasmic encephalitis who was admitted due to headache and seizures. A brain computed tomography scan disclosed a frontal hypodense lesion with a contrast ring enhancement. Brain abscess was suspected and she underwent a lesion puncture through a trepanation. The material extracted was purulent and the acid-fast smear was markedly positive. Timely medical and surgical approaches allowed a good outcome. Tuberculous abscesses should be considered in the differential diagnosis of focal brain lesions in AIDS patients. Surgical excision or stereotactic aspiration, and antituberculous treatment are the mainstay in the management of these uncommon lesions.
艾滋病患者的结核性脑脓肿被认为很罕见，文献中仅报道过8例。我们描述了一名34岁患艾滋病且曾患弓形虫脑炎的女性病例，她因头痛和癫痫发作入院。脑部计算机断层扫描显示额叶有一个低密度病变，伴有环形强化。怀疑为脑脓肿，她接受了开颅穿刺取病变组织。取出的物质为脓性，抗酸涂片呈强阳性。及时的内科和外科治疗取得了良好效果。在艾滋病患者局灶性脑病变的鉴别诊断中应考虑结核性脓肿。手术切除或立体定向抽吸以及抗结核治疗是这些罕见病变治疗的主要方法。
