Tuberculous abscess (TA) of the brain is a very rare entity and is characterized by encapsulated
collection of pus without evidence of classical granulomas. With the advent of AIDS, more
cases are being diagnosed, but very few have been reported in immunocompetent individuals.
We present a case of TA occurring in a 27-year-old immunocompetent, HIV negative patient. At
autopsy, the brain showed multiple encapsulated necrotic areas, 0.5 to 2 cm in diameter, which
showed only caseous necrosis with total absence of granulomatous reaction. AFB stain showed
plenty of tubercle bacilli and confirmed the diagnosis of tuberculous abscess. TA has to be
differentiated from the more commonly occurring tuberculomas. Most cases of tuberculomas
respond to multidrug therapy, while the definitive treatment in TA is surgical excision with a
complete course of antitubercular drug therapy.