Disseminated tuberculosis masquerading as a psychiatric illness-A case report

Tuberculosis (TB) can affect any organ, and at times more than one organ in any sequence, in which case it is referred to as disseminated tuberculosis (DTB). We report a patient who presented primarily for psychiatric symptoms of three months' duration, which later turned out to be a case of DT...

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Published in:JOURNAL OF FAMILY MEDICINE AND PRIMARY CARE
Main Authors: Bhaskar, Shalini; Noh, Mimi N. M.
Format: Article
Language:English
Published: WOLTERS KLUWER MEDKNOW PUBLICATIONS 2024
Subjects:
Online Access:https://www-webofscience-com.uitm.idm.oclc.org/wos/woscc/full-recordWOS:001373737800008
author Bhaskar
Shalini; Noh
Mimi N. M.
spellingShingle Bhaskar
Shalini; Noh
Mimi N. M.
Disseminated tuberculosis masquerading as a psychiatric illness-A case report
General & Internal Medicine
author_facet Bhaskar
Shalini; Noh
Mimi N. M.
author_sort Bhaskar
spelling Bhaskar, Shalini; Noh, Mimi N. M.
Disseminated tuberculosis masquerading as a psychiatric illness-A case report
JOURNAL OF FAMILY MEDICINE AND PRIMARY CARE
English
Article
Tuberculosis (TB) can affect any organ, and at times more than one organ in any sequence, in which case it is referred to as disseminated tuberculosis (DTB). We report a patient who presented primarily for psychiatric symptoms of three months' duration, which later turned out to be a case of DTB involving the central nervous system as well as the spine and lungs. Case Presentation: An elderly lady with subacute onset and worsening behavioural changes of three months' duration was referred for exclusion of organic brain disease. The neurological and respiratory examination, chest X-ray, electroencephalogram (EEG), and MRI of the brain were normal. She, however, had elevated C-reactive protein, ESR, and raised CSF opening pressure on lumbar puncture. The CSF cell counts, biochemistry, and cultures were within normal limits. Unable to detect a neurological cause for her illness, she was advised to consult a psychiatrist. Two months later she reported to us again, this time essentially for back pain. Investigations for the back pain (including CT spine) revealed a T12 compression fracture with irregularity of the left T12 pedicle and a para-spinal fluid collection. Pus drained from the collection showed mycobacterium tuberculosis bacteria on staining with ZN stain. The CT scan thorax also showed left lower lobe consolidation and a pleural effusion. Contrast CT scan brain revealed subtle meningeal enhancement at the right parietal region. With standard treatment with a four-drug anti-TB regimen (along with a short course of dexamethasone), she improved well. This case report indicates that the initial clinical presentation of TB in general, as well as DTB, can be misleading, resulting in delay in diagnosis and in initiating treatment.
WOLTERS KLUWER MEDKNOW PUBLICATIONS
2249-4863
2278-7135
2024
13
12
10.4103/jfmpc.jfmpc_930_24
General & Internal Medicine
gold
WOS:001373737800008
https://www-webofscience-com.uitm.idm.oclc.org/wos/woscc/full-recordWOS:001373737800008
title Disseminated tuberculosis masquerading as a psychiatric illness-A case report
title_short Disseminated tuberculosis masquerading as a psychiatric illness-A case report
title_full Disseminated tuberculosis masquerading as a psychiatric illness-A case report
title_fullStr Disseminated tuberculosis masquerading as a psychiatric illness-A case report
title_full_unstemmed Disseminated tuberculosis masquerading as a psychiatric illness-A case report
title_sort Disseminated tuberculosis masquerading as a psychiatric illness-A case report
container_title JOURNAL OF FAMILY MEDICINE AND PRIMARY CARE
language English
format Article
description Tuberculosis (TB) can affect any organ, and at times more than one organ in any sequence, in which case it is referred to as disseminated tuberculosis (DTB). We report a patient who presented primarily for psychiatric symptoms of three months' duration, which later turned out to be a case of DTB involving the central nervous system as well as the spine and lungs. Case Presentation: An elderly lady with subacute onset and worsening behavioural changes of three months' duration was referred for exclusion of organic brain disease. The neurological and respiratory examination, chest X-ray, electroencephalogram (EEG), and MRI of the brain were normal. She, however, had elevated C-reactive protein, ESR, and raised CSF opening pressure on lumbar puncture. The CSF cell counts, biochemistry, and cultures were within normal limits. Unable to detect a neurological cause for her illness, she was advised to consult a psychiatrist. Two months later she reported to us again, this time essentially for back pain. Investigations for the back pain (including CT spine) revealed a T12 compression fracture with irregularity of the left T12 pedicle and a para-spinal fluid collection. Pus drained from the collection showed mycobacterium tuberculosis bacteria on staining with ZN stain. The CT scan thorax also showed left lower lobe consolidation and a pleural effusion. Contrast CT scan brain revealed subtle meningeal enhancement at the right parietal region. With standard treatment with a four-drug anti-TB regimen (along with a short course of dexamethasone), she improved well. This case report indicates that the initial clinical presentation of TB in general, as well as DTB, can be misleading, resulting in delay in diagnosis and in initiating treatment.
publisher WOLTERS KLUWER MEDKNOW PUBLICATIONS
issn 2249-4863
2278-7135
publishDate 2024
container_volume 13
container_issue 12
doi_str_mv 10.4103/jfmpc.jfmpc_930_24
topic General & Internal Medicine
topic_facet General & Internal Medicine
accesstype gold
id WOS:001373737800008
url https://www-webofscience-com.uitm.idm.oclc.org/wos/woscc/full-recordWOS:001373737800008
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