Brain abscess with concurrent infection: tuberculosis and aspergillosis

Brain abscess is rarely caused by coinfection with different pathogens. A middle-aged immunocompetent woman developed right-sided focal motor seizures with Todd’s palsy. Brain imaging identified a frontal ring-enhancing lesion for which she started antitubercular therapy and corticosteroids. However, on tapering the corticosteroids, she developed a right-sided hemiparesis with increased lesion size. Excision biopsy identified coinfection with Mycobacterium tuberculosis and Aspergillus spp. She recovered well with antitubercular and antifungal agents. Coinfections with multiple pathogens pose diagnostic challenges due to overlapping or non-specific clinical and radiological features. This case underscores the importance of tissue diagnosis to enable appropriate therapy.