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CC BY-NC-ND 4.0 · Asian J Neurosurg 2025; 20(02): 291-300
DOI: 10.1055/s-0045-1802623
Original Article

Brain Abscess Mimicking Brain Tumors: A Systematic Review of Individual Patient's Data

Anis Choucha
1   Department of Neurosurgery, Aix Marseille University, APM, UH Timone, Marseille, France
2   Laboratory of Biomechanics and Application, UMRT24, Gustave Eiffel University, Aix Marseille University, Marseille, France
,
Matteo De Simone
3   Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana,” University of Salerno, Via S. Allende, Baronissi, Italy
,
Nathan Beucler
4   Department of Neurosurgery, Sainte-Anne Military Teaching Hospital, Toulon Cedex 9, France
,
Solenne Hulot
5   IHU Méditerranée Infection, Marseille, France
6   Aix-Marseille Université, APHM, MEPHI, IHU Méditerranée Infection, Marseille, France
,
Jean-Christophe Lagier
5   IHU Méditerranée Infection, Marseille, France
6   Aix-Marseille Université, APHM, MEPHI, IHU Méditerranée Infection, Marseille, France
,
Henry Dufour
1   Department of Neurosurgery, Aix Marseille University, APM, UH Timone, Marseille, France
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Funding None
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Abstract

Objectives Brain abscess is a worrisome condition with a 1-year mortality rate of 21% and a 32% rate of new-onset epilepsy. Brain magnetic resonance imaging (MRI) is strongly recommended as a screening modality with contrast-enhanced T1-weighted images, diffusion-weighted imaging (DWI), and attenuated diffusion coefficient. However, there is a 10% rate of false negative, which could potentially impact management and prognosis. Our systematic review aims at identifying risk factors for false negative.

Materials and Methods A database search of our institutions plus a systematic literature review was conducted using MEDLINE/PubMed, including studies of brain abscesses misdiagnosed as brain tumors. Data on patient demographics, clinical presentations, imaging findings, pathogens, treatments, and outcomes were extracted and analyzed. We present a case of a 59-year-old male with HIV, who developed a brain abscess misdiagnosed as a tumor. Initial symptoms included left-side weakness and weight loss. Imaging showed a ring-enhancing lesion in the right thalamus. The abscess was caused by T. gondii, and the patient was treated with sulfadiazine, pyrimethamine, ceftriaxone, and metronidazole, achieving a GOS-E score of 8 at 1 year.

Results The review included 14 studies, with 1 additional illustrative case, encompassing a total of 15 cases. Patients ranged from 39 to 77 years, with a mean age of 59 years. Comorbidities included human immunodeficiency virus (HIV), glioblastoma, breast cancer, arthritis, gastric cancer, and nephrotic syndrome. Common symptoms were hemiparesis, generalized seizures, headache, and confusion. Imaging often revealed ring-enhancing lesions with restricted diffusion on DWI. Lesions were located in various brain regions. Pathogens identified included 40% Nocardia species, Toxoplasma gondii, Mycobacterium tuberculosis, Aggregatibacter aphrophilus, Rickettsia typhi, Arcanobacterium haemolyticum, Aspergillus terreus, and Providencia rettgeri. Treatments involved antibiotics and, in some cases, surgical intervention. Outcomes measured by the Glasgow Outcome Scale-Extended (GOS-E) at 1 year indicated good recovery in most cases.

Conclusion Despite the high sensitivity and specificity of brain MRI in diagnosing brain abscesses, the standard protocol used for the past two decades still results in a 10% false-negative rate. Such inaccuracies can significantly impact the patient's management, potentially delaying antibiotic therapy and impacting the surgical planning, hence affecting the outcome. Immunocompromised patients are particularly vulnerable to misdiagnoses of brain abscesses as brain tumors. To improve diagnostic accuracy, new imaging techniques and computational tools are currently under investigation.

Keywords

brain abscess - systematic review - case reports - mimicking - toxoplasmosis - nocardia - tumor - MRI

Authors' Contributions

The study was conceptualized by A.C. and M.D.S., with methodology developed by N.B. and H.D. Formal analysis and investigation were conducted by A.C. and M.D.S., while the original draft was prepared collaboratively by A.C., M.D.S., N.B., and S.H. J.-C.L. and H.D. contributed to the review and editing of the manuscript. Resources were provided by A.C. and M.D.S., and supervision was carried out by J.-C.L. and H.D.


Ethical Approval

All principles in the Declaration of Helsinki were followed, and the Italian laws on privacy (Art. 20–21, DL 196/2003) as published in the Official Journal, volume 190, August 14, 2004, which explicitly waives the need for ethical approval for the use of anonymous data, were respected.




Publikationsverlauf

Artikel online veröffentlicht:
06. Februar 2025

© 2025. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Bodilsen J, Dalager-Pedersen M, van de Beek D, Brouwer MC, Nielsen H. Incidence and mortality of brain abscess in Denmark: a nationwide population-based study. Clin Microbiol Infect 2020; 26 (01) 95-100
    CrossrefPubMedSuche in Google Scholar
  • 2 Bodilsen J, Dalager-Pedersen M, van de Beek D, Brouwer MC, Nielsen H. Long-term mortality and epilepsy in patients after brain abscess: a nationwide population-based matched cohort study. Clin Infect Dis 2020; 71 (11) 2825-2832
    CrossrefPubMedSuche in Google Scholar
  • 3 Reddy JS, Mishra AM, Behari S. et al. The role of diffusion-weighted imaging in the differential diagnosis of intracranial cystic mass lesions: a report of 147 lesions. Surg Neurol 2006; 66 (03) 246-250 , discussion 250–251
    CrossrefPubMedSuche in Google Scholar
  • 4 Bodilsen J, D'Alessandris QG, Humphreys H. et al; ESCMID Study Group for Infections of the Brain (ESGIB). European Society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults. Clin Microbiol Infect 2024; 30 (01) 66-89
    CrossrefPubMedSuche in Google Scholar
  • 5 Newman-Toker DE, Peterson SM, Badihian S. et al. Diagnostic Errors in the Emergency Department: A Systematic Review [Internet]. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ); 2022
    Suche in Google Scholar
  • 6 Higgins JP, Green S. eds. Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series. 1st ed. Chichester, UK: Wiley; 2008
    Suche in Google Scholar
  • 7 Kourouma M, Joubert B, Berhouma M, Roux S, Meyronet D, Ducray F. Nocardia brain abscess mimicking tumor progression in an elderly glioblastoma patient treated with temozolomide radiochemotherapy. Rev Neurol (Paris) 2023; 179 (08) 929-931
    CrossrefPubMedSuche in Google Scholar
  • 8 Jung J, Shin I, Choi Y. A rare case of nontuberculous mycobacterial abscess mimicking brain tumor in an immunocompetent patient. Brain Tumor Res Treat 2023; 11 (03) 219-222
    CrossrefPubMedSuche in Google Scholar
  • 9 Karan M, Vučković N, Vuleković P, Rotim A, Lasica N, Rasulić L. Nocardial brain abscess mimicking lung cancer metastasis in immunocompetent patient with pulmonary nocardiasis: a case report. Acta Clin Croat 2019; 58 (03) 540-545
    PubMedSuche in Google Scholar
  • 10 de Laurentis C, Del Bene M, Fociani P, Tonello C, Pollo B, DiMeco F. 5-ALA fluorescence in case of brain abscess by aggregatibacter mimicking glioblastoma. World Neurosurg 2019; 125: 175-178
    CrossrefPubMedSuche in Google Scholar
  • 11 Jang Y, Moon J, Jun J-S. et al. Case of Rickettsia Typhi-induced brain abscess mimicking brain tumor. Osong Public Health Res Perspect 2018; 9: 122-125
    CrossrefPubMedSuche in Google Scholar
  • 12 Khullar P, Datta NR, Wahi IK, Kataria S. Brain abscess mimicking brain metastasis in breast cancer. J Egypt Natl Canc Inst 2016; 28 (01) 59-61
    CrossrefPubMedSuche in Google Scholar
  • 13 Asano M, Fujimoto N, Fuchimoto Y. et al. Brain abscess mimicking lung cancer metastases; a case report. Clin Imaging 2013; 37 (01) 147-150
    CrossrefPubMedSuche in Google Scholar
  • 14 Ouriemchi W, Jeddi D, Ziane Y, El Quessar A, Benouda A. Abcès cérébral àArcanobacterium haemolyticum mimant une tumeur cérébrale. Med Mal Infect 2011; 41 (07) 397-399
    CrossrefPubMedSuche in Google Scholar
  • 15 Cianfoni A, Calandrelli R, De Bonis P, Pompucci A, Lauriola L, Colosimo C. Nocardia brain abscess mimicking high-grade necrotic tumor on perfusion MRI. J Clin Neurosci 2010; 17 (08) 1080-1082
    CrossrefPubMedSuche in Google Scholar
  • 16 Damek DM, Lillehei KO, Kleinschmidt-DeMasters BK. Aspergillus terreus brain abscess mimicking tumor progression in a patient with treated glioblastoma multiforme. Clin Neuropathol 2008; 27 (06) 400-407
    CrossrefPubMedSuche in Google Scholar
  • 17 Iannotti CA, Hall GS, Procop GW, Tuohy MJ, Staugaitis SM, Weil RJ. Solitary Nocardia farcinica brain abscess in an immunocompetent adult mimicking metastatic brain tumor: rapid diagnosis by pyrosequencing and successful treatment. Surg Neurol 2009; 72 (01) 74-79 , discussion 79
    CrossrefPubMedSuche in Google Scholar
  • 18 Yamada SM, Nakai E, Toyonaga S, Nakabayashi H, Park KC, Shimizu K. A rapidly enlarging nocardial brain abscess mimicking malignant glioma. J Nippon Med Sch 2005; 72 (05) 308-311
    CrossrefPubMedSuche in Google Scholar
  • 19 Yokoyama T, Hyodo M, Hosoya Y. et al. Aggressive G-CSF-producing gastric cancer complicated by lung and brain abscesses, mimicking metastases. Gastric Cancer 2005; 8 (03) 198-201
    CrossrefPubMedSuche in Google Scholar
  • 20 Zhao Y, Lian B, Liu X. et al. Case report: cryptogenic giant brain abscess caused by Providencia rettgeri mimicking stroke and tumor in a patient with impaired immunity. Front Neurol 2022; 13: 1007435
    CrossrefPubMedSuche in Google Scholar
  • 21 Siddiqui H, Vakil S, Hassan M. Diagnostic accuracy of echo-planar diffusion-weighted imaging in the diagnosis of intra-cerebral abscess by taking histopathological findings as the gold standard. Cureus 2019; 11 (05) e4677
    PubMedSuche in Google Scholar
  • 22 Beucler N, Farah K, Choucha A. et al. Nocardia farcinica cerebral abscess: a systematic review of treatment strategies. Neurochirurgie 2022; 68 (01) 94-101
    CrossrefPubMedSuche in Google Scholar
  • 23 Farrell CJ, Hoh BL, Pisculli ML, Henson JW, Barker II FG, Curry Jr WT. Limitations of diffusion-weighted imaging in the diagnosis of postoperative infections. Neurosurgery 2008; 62 (03) 577-583 , discussion 577–583
    CrossrefPubMedSuche in Google Scholar
  • 24 Fu J-H, Chuang T-C, Chung H-W. et al. Discriminating pyogenic brain abscesses, necrotic glioblastomas, and necrotic metastatic brain tumors by means of susceptibility-weighted imaging. Eur Radiol 2015; 25 (05) 1413-1420
    CrossrefPubMedSuche in Google Scholar
  • 25 Lai P-H, Chung H-W, Chang H-C. et al. Susceptibility-weighted imaging provides complementary value to diffusion-weighted imaging in the differentiation between pyogenic brain abscesses, necrotic glioblastomas, and necrotic metastatic brain tumors. Eur J Radiol 2019; 117: 56-61
    CrossrefPubMedSuche in Google Scholar
  • 26 Martín-Noguerol T, Santos-Armentia E, Ramos A, Luna A. An update on susceptibility-weighted imaging in brain gliomas. Eur Radiol 2024; 34 (10) 6763-6775
    CrossrefPubMedSuche in Google Scholar
  • 27 Pal D, Bhattacharyya A, Husain M, Prasad KN, Pandey CM, Gupta RK. In vivo proton MR spectroscopy evaluation of pyogenic brain abscesses: a report of 194 cases. AJNR Am J Neuroradiol 2010; 31 (02) 360-366
    CrossrefPubMedSuche in Google Scholar
  • 28 De Simone M, Fontanella MM, Choucha A. et al. Current and future applications of arterial spin labeling MRI in cerebral arteriovenous malformations. Biomedicines 2024; 12 (04) 753
    CrossrefPubMedSuche in Google Scholar
  • 29 Erdogan C, Hakyemez B, Yildirim N, Parlak M. Brain abscess and cystic brain tumor: discrimination with dynamic susceptibility contrast perfusion-weighted MRI. J Comput Assist Tomogr 2005; 29 (05) 663-667
    CrossrefPubMedSuche in Google Scholar
  • 30 Cui L, Qin Z, Sun S, Feng W, Hou M, Yu D. Diffusion-weighted imaging-based radiomics model using automatic machine learning to differentiate cerebral cystic metastases from brain abscesses. J Cancer Res Clin Oncol 2024; 150 (03) 132
    CrossrefPubMedSuche in Google Scholar
  • 31 Smith SJ, Ughratdar I, MacArthur DC. Never go to sleep on undrained pus: a retrospective review of surgery for intraparenchymal cerebral abscess. Br J Neurosurg 2009; 23 (04) 412-417
    CrossrefPubMedSuche in Google Scholar