A case of tuberculous meningitis with multiple intracranial tuberculomas and miliary tuberculosis and choroid tubercles

Excerpt

A 23-year-old woman, negative for anti-human immunodeficiency virus, was admitted to our hospital with a 15-day history of fever, cough, headache, and convulsion. Physical examination was normal except for left side hypoesthesia. Laboratory findings were within normal range except for C-reactive protein (63 mg/L) and erythrocyte sedimentation rate (52 mm/h). A miliary pattern was detected by high-resolution computed tomography scanning (Fig. 1). Fundoscopic examination revealed bilateral choroid tubercles (Fig. 2). Since multiple intracranial tuberculomas were detected by cranial magnetic resonance imaging (MRI) (Fig. 3), isoniazid, rifampicin, ethambutol, pyrazinamide, and dexamethasone were administered, and antiepileptic therapy was started. Her symptoms disappeared on day 10. Deterioration in the patient’s condition, based on clinical and radiological tests, on month 1, 2, and 4 was considered to be a recurrent paradoxical reaction (PR). The patient was treated with prolonged high-dose steroid therapy and with the same antituberculosis therapeutic regimen. The intracranial nodules disappeared by month 7 (Fig. 4).

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