Miliary Brain Tuberculomas and Meningitis: Tuberculosis Beyond the Lungs
Gisela Vasconcelos, Lígia Rodrigues Santos, Catarina Couto, Margarida Silva Cruz, Alice Castro
Abstract
bacilli. The authors describe the case of a 47-year-old immunocompetent woman, diagnosed with miliary tuberculosis, with both lung and central nervous system involvement, who showed total recovery after starting anti-tuberculous drugs. The atypical neutrophilic-predominant pleocytosis and negative cerebrospinal fluid microbiological results made the diagnosis even more challenging. Since prognosis largely depends on timely treatment, recognition and prompt diagnosis is important. Thus, clinicians should be aware and treatment should be initiated as soon as the diagnosis is suspected. LEARNING POINTS: has low sensitivity, so a negative test does not eliminate the diagnosis.Cerebral magnetic resonance imaging is usually the test of choice, given its superiority in CNS TB diagnosis over computed tomography (CT), which can be normal.Chest x-ray may appear normal and miss miliary TB, which however a CT scan can identify.