Brain Tumor Res Treat.  2023 Jul;11(3):219-222. 10.14791/btrt.2023.0019.

A Rare Case of Nontuberculous Mycobacterial Abscess Mimicking Brain Tumor in an Immunocompetent Patient

• Jung J
• Shin I
• Choi Y

• KMID: 2545110
• DOI: http://doi.org/10.14791/btrt.2023.0019

Abstract

Nontuberculous mycobacteria (NTM) is a type of bacteria that typically infects the pulmonary system, and NTM–central nervous system (CNS) infection, which occurs in the brain, is a very rare disease. A 64-year-old female patient presented with seizures as the main symptom and was found to have a mass of less than 1 cm in the right temporal lobe with accompanying edema. Although diseases such as tumor metastasis and parasitic cyst were suspected, the patient underwent a surgical resection, and NTM-CNS infection with abscess was diagnosed through biopsy. Antibiotic treatment was initiated after surgery, and the patient has been followed up without any significant symptoms. In this report, we review a rare case of NTM-CNS infection and discuss the understanding and treatment of this disease.

Keyword

Nontuberculous mycobacteria; Central nervous system infections

Figure

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  Fig. 1 Preoperative MRI images showing a lesion in the right temporal lobe. A: A circular lesion of approximately 1 cm in size, which is strongly enhanced with contrast, can be seen on contrast-enhanced image. B: On the axial T2 fluid-attenuated inversion recovery image, mild edema is visible in the periphery of the lesion. C: Central diffusion restriction is shown in diffusion-weighted sequence.

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  Fig. 2 Postoperative MRI images of the patient. A: The lesion that was enhanced with contrast before the surgery is not visible anymore. B: The surrounding area appears to have been resected on T2 fluid-attenuated inversion recovery image. C: No central diffusion restriction can be seen in diffusion-weighted image.

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  Fig. 3 A biopsy image stained with H&E at a magnification of ×100. The brain tissue shows abscess pockets containing cholesterol cleft, abscess, or fibrous wall (black arrow). Some of them show granulomatous inflammation in the abscess wall (red arrow). Fungus or acid fast bacilli cannot be found on special staining.

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  Fig. 4 In the MRI images taken approximately 7 years after the surgery, it can be confirmed that there is no sign of recurrence. A: Axial contrast-enhanced image. B: Axial T2 fluid-attenuated inversion recovery image.

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