Encephalitis due to miliary tuberculosis in a patient with human immunodeficiency virus: A case report

Miliary tuberculosis (TB) is a form of extrapulmonary tuberculosis due to hematogenous dissemination and occurs more frequently in immunocompromised patients. Clinical manifestations are non-specific and varied with the related organ, including central nervous system involvement. We report the first case of encephalitis associated with miliary TB in human immunodeficiency virus (HIV)-the infected patient.

A 39-year-old male presented with severe headache, numbness in the left side of the body, and partial seizure for two weeks. Previously, the patient complaining of several weeks of cough with generalized weakness. Physical examination showed progressive left-sided weakness and numbness. Chest radiograph showed uniform-sized small nodules randomly distributed diffusely throughout the lungs. Plain computer tomography (CT) brain imaging showed hypodensity in the right parietal region. Laboratory findings showed positive for the HIV antibody test, CD4 counts were 84 cells/μL and acid-fast bacilli from sputum. He was administered empirical anti-TB treatment and was discharged without any complications on day 10.

This is a rare cause of encephalitis due to miliary TB infection in HIV patients. Even though central nervous system involvement is rare in miliary TB infection, physicians should be aware of atypical features of the disease and comorbidity that may predispose this infection.