Disseminated tuberculosis of the central nervous system responsive to rifabutin

Multiple cerebral tuberculomas are now very rare. We report the case of a young man with an 8-month history of headache, febricula and abscess of the left tibiotarsal joint, which was found to contain mycobacterium tuberculosis. Chest X-rays revealed miliariform dissemination to both lungs while CT and MR brain scans revealed numerous small nodules, especially in the posterior cranial fossa. Despite anti-tuberculosis therapy the patient developed a right pyramidal hemisyndrome and intracranial hypertension. The inclusion of rifabutin in the treatment schedule was followed by rapid improvement and a year later the patient was in good health and free from cerebral and pulmonary lesions. The interest of the case lies in the multiplicity of sites of the TB process in a non immunodepressed patient, the dissemination to the CNS without meningeal involvement, the resistance to standard antimycobacterials and the swift response to rifabutin.