The objective of our study was to report a rare case with a large brain abscess related to central nervous system immune reconstitution inflammatory syndrome (IRIS) and to discuss the operative strategy for it. Brain abscess with HIV co-infection is considered to be a critical infectious condition that requires neurosurgical intervention. The presentation of IRIS may worsen the patient's condition after the initiation of antiretroviral therapy, especially in IRIS of the central nervous system. Only a few cases of IRIS-related brain abscess have been reported in the current literature, with discussion of the operative strategy. A 30-year-old man was diagnosed with HIV infection in 2007 and he developed right-sided convulsion episodes in 2008. His first brain computed tomography (CT) scan revealed two intracranial cysts, and his symptoms were well controlled by anticonvulsant treatment. He also initiated antiretroviral therapy in the same year. However, his neurological conditions gradually worsened with sensory loss, weakness, visual impairment on the right side, as well as motor aphasia. A CT scan in 2011 revealed a well-encapsulated, hypodense 8cm×9cm intracranial lesion in the left frontal parietal lobe with a 3-cm midline shift. Surgery was performed with a combination of direct suction and quick-suturing of the incision. The abscess capsule was enucleated completely. After surgical removal, he recovered well and remains functional at work in the following year with only minor neurological sequelae. In conclusion, this case illustrates well the clinical course of brain abscess resulting from IRIS in Swaziland, where the prevalence rate of HIV infection is relatively high and delay in diagnosis and treatment is common. The use of a modified excision method for HIV co-infection brain abscess may be considered the operative strategy, with a probable good outcome in such a resource-limited area as Swaziland. © 2013.
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