[Asymptomatic multiple intracranial tuberculous nodules detected in a case of miliary tuberculosis]

A case of multiple intracranial tuberculous nodule following miliary tuberculosis was reported. The case was a 19-year-old woman visited a general practitioner, because of fever. Chest x-ray film on the first visit showed diffuse granular shadows in her both lungs with pleural effusion in the left side. The case was diagnosed as bacterial pneumonia, and was treated with antibiotics. She had been getting worse, and the doctor finally examined her sputum, and tubercle bacilli were seen in her sputum (Gaffky 4) by the Ziehl Neelsen's staining. She was introduced to our hospital. Chest x-ray film on admission showed diffuse granular shadows in her both lungs and she was diagnosed her as miliary tuberculosis, and anti-tuberculous therapy was quickly started. She didn't complain of any neurological disorders, but her brain CT showed several nodules in the left cerebral cortex enhanced with contrast medium. T1 weighted MRI enhanced by Gd-DTPA revealed abnormal enhancements in the cerebrum, the cerebellum, and the midbrain. She was treated with anti-epileptic drugs, but after 65 days, she started to suffer from epileptic stroke. Six months later, her brain lesions have improved by the use of anti-tuberculosis drugs and anti-epileptic drugs. The incidence of tuberculosis has decreased in Japan, and, many doctors did not show concern on, thus, a doctor's delay is a serious problem in Japan. Advocary should be made to doctors to detect tuberculous patients as early as possible.