A Rare Case of Disseminated Tuberculosis Presenting As a Frontal Headache and Photophobia in the UK

Tuberculosis is a disease caused by Mycobacterium tuberculosis (TB), demonstrating a vast clinical spectrum that can potentially involve all systems of the body. We present the case of a female in her late 20s, with an employment background in healthcare. She recently moved to the UK from India. The patient presented to the emergency department with a frontal headache and photophobia. Initial CT head demonstrated asymmetrical right-sided grey-matter hypoattenuation. Subsequent imaging showed multiple rim-enhancing lesions throughout the cerebral and cerebellar neuroparenchyma, scattered miliary nodules in both lungs, confluent necrotic mediastinal lymphadenopathy, collections in the psoas muscles bilaterally with extension on the left side into the iliacus, erector spinae and gluteal region and destructive sacroiliac joint involvement. This case highlights the complexity and variability of the presentation of extrapulmonary TB, subsequent imaging findings and diagnosis.