Cerebral Brain Abscess Mimicking Psychiatric Presentation in an HIV-Positive Patient With Post-traumatic Stress Disorder and Bipolar Disorder: A Case Report

Cerebral brain abscesses, though relatively rare, present significant clinical challenges with high morbidity and mortality rates, especially in immunocompromised patients. These abscesses can mimic psychiatric disorders due to their space-occupying effects, complicating diagnosis and treatment. This case report details a 47-year-old HIV-positive African American woman with a history of bipolar disorder, post-traumatic stress disorder (PTSD), and anxiety who presented to the psychiatric emergency department with altered mental status, catatonia, and disorganized behavior. Initial assessment was challenging due to her psychiatric history and unusual symptoms, including catatonia and disorganized behavior. Laboratory findings indicated acute kidney injury and hypernatremia. Concerns about increased intracranial pressure led to imaging, revealing a large left frontal lobe mass with significant edema and midline shift, suggestive of a cerebral abscess with obstructive hydrocephalus. The patient underwent emergent intubation, surgical aspiration of the abscess, ventricular-peritoneal shunt placement, and left hemicraniectomy, with cultures identifying <i>Streptococcus viridans</i>. Post-operatively, she showed gradual improvement in mental status and motor function, ultimately being discharged to a rehabilitation facility. This case underscores the importance of considering organic etiologies, including brain abscesses, in immunocompromised patients with new or atypical psychiatric presentations. Comprehensive diagnostic assessments and neuroimaging are crucial for accurate diagnosis and timely intervention, with multidisciplinary approaches essential for optimal management and improved patient outcomes.