SHM Converge Scientific Abstract ePoster Gallery-Miliary Tb, Meningitis, and Tuberculoma: A Case Report

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This case report describes a severe presentation of disseminated tuberculosis in a 30-year-old homeless man with active hepatitis C and severe alcohol use disorder, originally from Guatemala. He presented with two months of frontal headache, fevers, chills, and weight loss, raising concern for tuberculosis given his social and medical risk factors.<br /><br />Initial evaluation showed mild hyponatremia and elevated AST. Lumbar puncture revealed lymphocytic pleocytosis, elevated CSF protein, and low glucose, findings consistent with tuberculous meningitis. Although CSF AFB stains were negative and molecular testing was limited by insufficient sample, MRI of the brain showed a 2 x 2 cm rim-enhancing right frontal lesion with leptomeningeal enhancement. CT imaging of the chest, abdomen, and pelvis demonstrated numerous bilateral pulmonary nodules and widespread lymphadenopathy, supporting miliary tuberculosis.<br /><br />The patient clinically worsened and became febrile and obtunded, requiring emergent right craniotomy and resection of the brain lesion. Intraoperative findings suggested tuberculosis, and tissue analysis confirmed AFB-positive, culture-positive disease without rifampin resistance. Follow-up MRI showed multiple small infarcts and persistent leptomeningeal enhancement, further supporting TB meningitis.<br /><br />He was treated with high-dose dexamethasone and standard first-line antituberculous therapy: rifampin, isoniazid with vitamin B6, pyrazinamide, and ethambutol. The report emphasizes that miliary TB with tuberculous meningitis can present atypically in immunocompromised or socially vulnerable patients. Diagnosis requires combining history, imaging, and CSF studies, since negative molecular or AFB testing does not exclude disease. Early recognition and prompt treatment are critical because this condition carries high mortality.

Asset Subtitle

Rebecca Zeidman

Meta Tag

Author List Rebecca Zeidman, Stephen Maslak, Tenzin Khangkar, Tina Kana, Umair Abbas

Category Clinical Vignettes

Concept Disseminated Tuberculosis

Concept Neurotuberculosis

Concept Anti-tuberculosis Regimen

Concept Mycobacterium tuberculosis

Concept Cerebrospinal Fluid Studies

Distinguished Non-Finalist

Presenter Organization Lenox Hill Hospital

Presenting Author Rebecca Zeidman

Track Adult

Keywords

disseminated tuberculosis

tuberculous meningitis

miliary tuberculosis

brain lesion

lymphocytic pleocytosis

leptomeningeal enhancement

AFB-positive

rifampin resistance

antituberculous therapy

homeless patient

Disseminated Tuberculosis

Neurotuberculosis

Anti-tuberculosis Regimen

Mycobacterium tuberculosis

Cerebrospinal Fluid Studies