An infant with central nervous system complications of disseminated tuberculosis.

A previously well, nine-month-old, Canadian-born, Caucasian infant presented with one month history of cough, irritability, and poor weight gain. Her past medical history was significant for open-heart surgery at age four months, with repair of a ventricular septal defect, closure of an atrial septal defect, and ligation of patent ductus arteriosus. There were no operative complications. Her development was normal for age. She had received her routine immunizations. There was no known infectious diseases contact or exposure to farm animals. Initial examination revealed a lethargic infant with mild tachypnea and low-grade fever. Aside from decreased air entry at the right upper lobe (RUL), her general examination was normal. A chest x-ray confirmed complete RULconsolidation (Figure 1). Gram stain and routine bacteriologic culture from the bronchoalveolar lavage (BAL) were negative. On the third day of admission, she developed meningismus, bulging anterior fontanel, and new right-body focal and secondary generalized seizures. Brain computed tomography (CT) and magnetic