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 <i>Mycobacterium tuberculosis</i> and <i>Aspergillus spp</i> 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.