Presentation
Headache, fever, dizziness, vomiting, body pain, and weight loss for 2 months worsened over the last 4-5 days. TB contact was positive. Blood ESR and CRP were high, and CSF protein (112 mg/dl) and TLC (60/cu mm) were very high.
Patient Data
Diffuse micro-nodular opacities scattered throughout both lungs, without zonal or lobar preference (miliary pattern).
Multiple, small, well-defined, ring-enhancing, and diffusely enhancing intra-axial and extra-axial lesions, scattered in the brain parenchyma, in both infra and supra-tentorial compartments. These lesions are hyper-intense on T2WI/FLAIR sequences. Thick leptomeningeal enhancement is noted along the right Sylvian fissure.
There is a large area of diffusion restriction involving the right basal ganglia and right thalamus.
Case Discussion
Based on the clinical picture, blood and CSF analysis, and chest radiography, the diagnosis of pulmonary miliary tuberculosis and CNS tuberculosis was made.
Ten days after the initial workup, the patient developed left-sided weakness, and then an MRI of the brain was performed. The MRI revealed typical CNS manifestations of tuberculosis infection as well as an acute ischemic infarct in the right basal ganglia, possibly due to vasculitis.
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