A case of pulmonary tuberculosis with tuberculoma

Introduction: 78 year old female presented to the Emergency with altered sensorium since two hours with the BP OF 240/120mmHg with the GCS of 9/15. Right plantar extensor with pupils bilateral equal and reactive with normal fundus, bronchial breath sounds on left infra clavicular and mammary area. Investigation: Blood parameters showed microcytic hypochromic picture with haemoglobin of 10.9,increased total counts of 12000 and normal platelets renal and liver function tests, normal serum electrolytes and urine analysis. ECG showed lvh strain, Chest x-ray showed left upper lobe non homogenous opacity present suggestive of pneumonia. SPUTUM CBNAAT came positive MTB Detectable HRCT Thorax confirmed pneumonia suggestive of tubercular origin. CT BRAIN showed? Granuloma/ ring enhancing lesion in left parietal lobe. MRI BRAIN suggestive of ring enhancing lesion mostly probably tuberculoma. 2D Echo shows hypertensive heart disease with concentric left ventricular hypertrophy with normal systolic function and grade 2 LV diastolic dysfunction. Discussions: Patient was diagnosed to have accelerated hypertension with sputum positive pulmonarytuberculosis and Tuberculoma inthe left parietal lobe. Patient was started on ATT with pyridoxine after confirmation of PTB and antihypertensives. Patient came for follow up after 1week with all parameters normal and no vomiting or headache. Conclusions: We have come to a conclusion that any patients who presents with altered sensorium needs to suspect neuro infection. Clinical examination along with investigations will give you a clear picture and confirmed diagnosis of the same.