The Report of a Case with Rare Presentation of Intracranial Tuberculom and Pulmonary Tuberculosis with Normal CXR

Intracranial Tuberculoma is a rare form of Tuberculosis (Tb) with presentation of multiple space occupying lesions. Clinical manifestations of intracranial Tuberculoma are dependent to the site of involvement. MRI, positive smear and the evidences of other organs infection can help us to diagnose intracranial Tb. We should consider tuberculosis in patients with unusual presentations even when presents with normal CXR. A ۲۴ years old man was admitted to the infectious ward. He presented with a decreased consciousness level and weakness in four limbs during the past ۷ days. He complained of a productive cough since ۳months ago and knee arthralgia from ۵ months ago. He was febrile and ill appearance. Breathing sound was decreased at the base of the right lung among with Cracle sound. Patient was quadriplegic without deep tendon reflex. Laboratory tests showed the rise of liver transaminases and elevation in the serum ESR and CRP. Gastric fluid smear was positive for AFB. In brain MRI, multiple hyperdense heterogen lesions were reported. The patient was treated with anti tuberculosis drugs and prednisolon. He discharged from the hospital with good general appearance after ۲۱ days.

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Key words: Tuberculoma ، Tb ، Intracranial Tb ، pulmonary