Isolated Tuberculous Brain Abscess in a 7-Year-Old Child: A Rare Presentation of CNS Tuberculosis: A Case Report.

Background. Tuberculous brain abscess (TBA) is a rare and often overlooked manifestation of central nervous system tuberculosis (CNS TB), particularly in children. The occurrence of isolated TBAs, where there is no clinical or radiological evidence of tuberculosis elsewhere in the body, is exceedingly uncommon in pediatric patients. Case presentation. A 7-year-old girl presented with a two-week history of persistent headaches and progressive left-sided weakness. Initially diagnosed and treated for pyogenic brain abscesses. However, microbiological and histopathological analysis of the drained abscess revealed the presence of acid-fast bacilli (AFB) and a positive CBNAAT for Mycobacterium tuberculosis, confirming TBA. The patient was successfully treated with surgical drainage and a course of anti-tubercular therapy (ATT). Conclusion. Isolated TBA, though rare, is a critical diagnostic consideration in pediatric CNS TB, especially in tuberculosis-endemic regions. This case emphasizes the need to consider Mycobacterium tuberculosis in the differential diagnosis of pediatric brain abscesses, particularly in regions with a high tuberculosis burden. It also highlights the need for routine tuberculosis testing, including CBNAAT, on all pus samples from intracranial abscesses to ensure timely and accurate diagnosis.