Paradoxical Enlargement of Tuberculous Brain Abscess during Drug Treatment: A Case Report

SK Ng, XL Zhu, WS Poon
Correspondence: Dr W S Poon

ABSTRACT
This is a case report of a patient suffering from tuberculous (TB) brain abscesses. Despite supervised and appropriate anti-TB chemotherapy, the size of the abscesses paradoxically increased, accompanied by clinical deterioration at 1 month. A second aspiration was performed which yielded a large amount of viable tubercle bacilli. The same drug regimen was continued. This was followed by complete resolution of the lesions in 12 months. Hence TB brain abscess which remains culture and smear positive after four weeks treatment may not represent treatment failure.

Keywords: tuberculous, brain abscesses, paradoxical deterioration
Singapore Med J 2001; 42(7): 325-327