RARE PRESENTATION OF DISSEMINATED TB: MULTIPLE RING ENHANCING LESIONS IN BRAIN

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Cerebral tuberculomas is a rare form of extrapulmonary tuberculosis (TB). Due to lack tests available for confirmatory diagnosis, the diagnosis difficult. However, missing could lead catastrophic consequences. Here, we report case disseminated presented with multiple ring enhancing lesions in brain. CASE PRESENTATION: A 75-year-old male progressive generalized weakness associated fever and chills 3 weeks. He has history bronchial carcinoid tumor status post radiation therapy, Waldenstrom's macroglobulinemia, heart failure reduced ejection fraction, implantable cardiac defibrillator placement, coronary artery disease, stroke, type 1 diabetes. appeared tired mild symmetrical lower limb weakness, but there were no meningeal signs. CT head revealed innumerable ring-enhancing both cerebrum, cerebellum brainstem. Analysis cerebrospinal fluid (CSF) showed lymphocyte predominant pleocytosis (WBC 253/cumm), elevated protein (155 mg/dl) low glucose ratio (CSF/serum 0.4). Empirical treatment meningitis started, intermittent spiking persisted. Unfortunately, patient had arrest while he was undergoing brain MRI. Postmortem autopsy necrotizing granulomatous nodules AFB positive bacteria organs, including brain, lung, liver, spleen, thyroid, pulmonary lymph nodes. Mycobacterium complex isolated from CSF subsequently. TB made. Upon further investigation, did not have exposure history, except travelling around globe when young. DISCUSSION: The differential broad, which include neurocysticercosis, toxoplasmosis, cryptococcosis, bacterial abscess, CNS lymphoma cerebral metastases. Given complicated medical our risk factor TB, empirical given. In such clinical scenario, more sensitive test, e.g. nucleic acid amplification (NAA), would be deciding initiation therapy. data support use NAA patients at tuberculoma. Future studies warranted explore setting extra-pulmonary tuberculosis. CONCLUSIONS: Disseminated lethal disease if missed. remains huge challenge, especially symptoms are absent. high index suspicion required diagnose treat More researches expedite TB. REFERENCE #1: Suárez I, Fünger SM, Jung N, et al. Severe HIV-negative refugees. Lancet Infect Dis 2019; 19: e352–e359. #2: Lewinsohn DM, Leonard MK, LoBue PA, Official American Thoracic Society/Infectious Diseases Society America/Centers Disease Control Prevention practice guidelines: adults children. Clin 2017; 64:e1–33. DISCLOSURES: No relevant relationships by Gin Yi Lee, source=Web Response Kaiqing Lin, Guangchen Zou,