Miliary Brain Tuberculomas and Meningitis: Tuberculosis Beyond the Lungs

Area of Science:

• Infectious Diseases
• Neurology
• Radiology

Background:

• Tuberculosis (TB) is a common infectious disease globally.
• Miliary tuberculosis is a rare, severe manifestation of TB caused by widespread dissemination of Mycobacterium tuberculosis.
• Central nervous system tuberculosis (CNS TB) presents diagnostic challenges.

Purpose of the Study:

• To report a case of miliary tuberculosis with concurrent lung and CNS involvement in an immunocompetent adult.
• To highlight diagnostic challenges posed by atypical cerebrospinal fluid (CSF) findings and negative microbiological tests.
• To emphasize the importance of prompt diagnosis and treatment for favorable outcomes in CNS TB.

Main Methods:

• Case report of a 47-year-old immunocompetent female.
• Diagnostic workup included chest X-ray, CT scan, MRI of the brain, and CSF analysis (cell count, differential, microbiology).
• Treatment involved standard anti-tuberculous drugs.

Main Results:

• The patient presented with miliary tuberculosis affecting both lungs and the central nervous system.
• Cerebrospinal fluid analysis revealed neutrophilic-predominant pleocytosis with negative microbiological results for Mycobacterium tuberculosis.
• The patient achieved total recovery after initiating anti-tuberculous therapy.

Conclusions:

• Cerebrospinal fluid findings in CNS TB can be variable, including normal or atypical neutrophilic predominance, and microbiological tests have low sensitivity.
• Imaging modalities like MRI are superior to CT for diagnosing CNS TB, although chest X-rays can be normal in miliary TB.
• Prompt recognition and initiation of treatment are critical for improving prognosis in miliary and CNS tuberculosis.