A Young Patient with Stroke and Primary Tuberculosis.

Area of Science:

• Internal Medicine
• Infectious Diseases
• Neurology

Background:

• Tuberculosis (TB) remains a significant global health challenge, often presenting with diverse clinical manifestations.
• Extrapulmonary TB (EPTB) can affect multiple organ systems, complicating diagnosis.
• Neurovasculitis is a rare but serious complication of TB, leading to neurological deficits.

Observation:

• A 21-year-old immunocompetent woman presented with acute neurological symptoms (left hemiparesis), fever, dyspnea, and tachycardia.
• Initial diagnosis considered infective endocarditis, but further investigations revealed primary pulmonary tuberculosis (PTB) with pericardial effusion, thoracic lymphadenitis, and neurovasculitis.
• Neurological deficit (left hemiparesis) was attributed to a pontine infarct secondary to TB-induced neurovasculitis.

Findings:

• Imaging studies including echocardiography, CT thorax, and MRI brain confirmed the diagnosis of PTB and EPTB with associated complications.
• The patient showed significant clinical improvement following anti-tuberculosis treatment.
• Crucially, the patient had no underlying immunodeficiency, challenging typical assumptions about TB presentation.

Implications:

• This case highlights the importance of considering PTB and EPTB in the differential diagnosis of febrile illnesses, regardless of immune status.
• Atypical presentations of TB, including neurological involvement, necessitate a high index of suspicion.
• Prompt diagnosis and management of TB are vital to prevent severe complications and improve patient outcomes, particularly in endemic regions like India.