Starry Sky In Disseminated Tuberculosis

Published:October 31, 2020DOI:
      A 31-year-old man had fever, cough, and lymphadenopathy 11 months ago. He had close contact with his uncle, who had pulmonary tuberculosis. His investigations, including bronchoalveolar lavage and lymph node biopsy, were inconclusive for tuberculosis and sarcoidosis. He was prescribed prednisolone 40 mg with an empirical diagnosis of sarcoidosis. His fever and cough subsided after 1 month, and lymphadenopathy disappeared after 3 months. Prednisolone was stopped after 4 months. Nine months later, he was readmitted with a 2-week history of headache, seizure, left-sided weakness, and altered sensorium. Headache was holocranial, continuous, and of moderate severity. On the 10th day of headache, he developed multiple attacks of generalized tonic-clonic seiures for which he was prescribed intravenous midazolam and levetiracetam. Following seizures, he became drowsy and started having extensor posturing. This time, he did not have fever, cough, hemoptysis, or lymphadenopathy.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Gambhir S
        • Kumar M
        • Ravina M
        • Bhoi SK
        • Kalita J
        • Misra UK
        Role of 18F-FDG PET in demonstrating disease burden in patients with tuberculous meningitis.
        J Neurol Sci. 2016; 370: 196-200
        • Wadia N
        • Desai S
        • Bhatt M
        Disseminated cysticercosis. New observations, including CT scan findings and experience with treatment by praziquantel.
        Brain. 1988; 111: 597-614
        • Martinez HR
        • Rangel-Guerra R
        • Elizondo G
        • et al.
        MR imaging in neurocysticercosis: a study of 56 cases.
        AJNR Am J Neuroradiol. 1989; 10: 1011-1019
        • Misra UK
        • Kalita J
        • Kumar M
        Safety and efficacy of fludrocortisone in the treatment of cerebral salt wasting in patients with tuberculous meningitis: a randomized clinical trial.
        JAMA Neurol. 2018; 75: 1383-1391
        • Kumar M
        • Kalita J
        • Tripathi A
        • Misra UK
        Is drug-induced hepatitis related to the severity of tuberculous meningitis?.
        Trans R Soc Trop Med Hyg. 2017; 111: 520-526