Management and outcome of brain abscess in renal transplant recipients
M J Arunkumara, Vedantam Rajshekhara, Mathew J Chandya, Paulose P Thomasb, Chacko Korula Jacobb
a Christian Medical
College and Hospital, Vellore 632 004, Tamil Nadu, India
Department of Neurological Sciences, b Department of Nephrology
Correspondence to: Dr Rajshekhar
Submitted 3 February
1999;
Accepted 10 September 1999
Although infection is the commonest central nervous system
complication following renal transplantation, brain abscess is uncommon. Over the last 11 years, five renal transplant recipients who
had brain abscesses were treated by computed tomography (CT)-guided stereotactic aspiration. Three patients had a fungal abscess, one a
tuberculous abscess and the other had a methicillin-resistant Staphylococcus aureus abscess.
One patient required a craniotomy for the excision of a fungal abscess
which was persistent after two CT-guided stereotactic aspirations. The
survivors in this group are the patient with a tuberculous abscess who
is alive and well 5 years after diagnosis, and another with a
dematiaceous fungal abscess (phaeohyphomycosis). CT-guided stereotactic
surgery is minimally invasive, and can safely be performed in these
patients. It often leads to an aetiological diagnosis in renal
transplant recipients with brain abscesses. Specific antibiotic
management directed towards the causative organism rather than
empirical treatment can be instituted following the procedure. Although the ultimate prognosis in these patients is bleak even with specific antibiotic therapy, an occasional patient might have a good outcome with prompt and appropriate therapy.
Keywords: brain abscess; computed tomography guided stereotaxy; renal transplant recipients
© 2000 by The Fellowship of Postgraduate Medicine
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