Tuberculous abscess: The correct perspective.

Dear Sir,

I read with interest the article titled “Intramedullary tubercular abscess with syrinx formation” by Khalid et al., in the January-April, 2012 issue.[1] The authors have called caseating tuberculous granuloma as a tuberculous abscess, which is incorrect. Tuberculous abscess, by definition, is an abscess containing tubercle bacilli, with the wall showing only inflammatory cells, but no epitheloid or Langhan′s giant cells, i.e. granuloma formation (Whitener, 1978).[2] This is due to a defective immune response where delayed hypersensitivity reaction is suppressed with preservation of acute inflammatory response. Hence, tuberculous abscess is distinctly different from caseating tuberculous granuloma. The incidence of tuberculous abscess itself is uncommon.[34] The case reported in the above article falls into the category of caseating tuberculoma rather than a tuberculous abscess. Intramedullary tuberculoma is not uncommon, but intramedullary tuberculous abscess is extremely rare.[5] This factual error needs to be corrected.