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Starry Sky In Disseminated Tuberculosis

Published:October 31, 2020DOI:https://doi.org/10.1016/j.amjmed.2020.09.050
      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.
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