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Disseminated tuberculosis masquerading as a psychiatric illness-A case report
Shalini Bhaskar1, Mimi N M Noh1
1Department of Medicine, Universiti Teknologi MARA, Puncak Alam, Malaysia, Asia.
Journal of Family Medicine and Primary Care
|January 10, 2025
Summary
Disseminated tuberculosis (DTB) can present with subtle psychiatric symptoms, delaying diagnosis. This case highlights DTB affecting the brain, spine, and lungs, emphasizing the need for broad diagnostic consideration.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Disseminated tuberculosis (DTB) can affect multiple organs sequentially.
- Initial presentation of DTB can be atypical, mimicking other conditions.
- Psychiatric symptoms can be an early, misleading sign of DTB.
Observation:
- An elderly patient presented with subacute behavioral changes and normal initial neurological workup.
- Subsequent development of back pain led to the discovery of a T12 compression fracture with Mycobacterium tuberculosis.
- Thoracic imaging revealed lung consolidation and pleural effusion; brain imaging showed subtle meningeal enhancement.
Findings:
- Pus from a spinal collection confirmed Mycobacterium tuberculosis via Ziehl-Neelsen staining.
- The patient had elevated inflammatory markers (CRP, ESR) and increased CSF opening pressure.
- Diagnosis of disseminated tuberculosis involving CNS, spine, and lungs was established.
Implications:
- This case underscores the diagnostic challenges posed by atypical presentations of disseminated tuberculosis.
- Early consideration of infectious etiologies, including DTB, is crucial even with normal initial investigations.
- Prompt diagnosis and multi-drug anti-TB treatment led to successful patient recovery.
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