27th June 2023

Cerebral abscesses in HIV

Brain abscesses in patients with HIV can be caused by tuberculomas and tuberculous abscesses. Tuberculous abscesses are larger, often solitary, and demonstrate ring enhancement. Pyogenic brain abscesses are less common than lymphoma and opportunistic infections. Patients with HIV are more likely to have multiple abscesses and infection caused by several bacteria, including:

• Listeria
• Cryptococcus
• Nocardia

Presentation includes:

• Headache
• Fevers
• Meningism
• Altered mental state
• Nausea and vomiting
• Seizures
• Papilloedema
• Focal neurological deficit

Cerebral aspergillosis has a very high mortality. Management typically involves both surgery (CT-guided stereotactic drainage) and medication. Medications for HIV patients need to cover for toxoplasmosis, frequently with pyrimethamine and sulfadiazine, or clindamycin. Oedema associated with abscesses causing significant mass effect is managed with corticosteroids.