Beyond Negative Microbiology: Disseminated Tuberculosis with Multiple Cerebral Tuberculomas in an Immunosuppressed Patient

Dr. Amrutha P, Dr. Ravishankar S N, Dr. Bharath D S

Abstract: Tuberculosis (TB) remains a major infectious disease burden in India, and extrapulmonary or disseminated forms may be microbiologically negative, especially in immunosuppressed hosts with paucibacillary disease. We report a 61-year-old man with rapidly progressive glomerulonephritis (RPGN) on cyclophosphamide who presented with acute right upper-limb weakness, generalised weakness, giddiness, fever and cough. MRI brain revealed multiple cerebral and cerebellar ring-enhancing and nodular lesions. Chest radiograph and HRCT chest demonstrated fibrocavitatory disease with centrilobular ground-glass nodules and tree-in-bud endobronchial spread, supporting active pulmonary tuberculosis. Despite negative sputum AFB smears, sputum/CSF MTB/, CSF cytology, India ink and Toxoplasma PCR, a clinico-radiological diagnosis of probable disseminated tuberculosis with multiple cerebral tuberculomas was made and empirical anti-tubercular therapy was commenced. The patient later developed sepsis-like deterioration and succumbed. The case highlights that, in TB-endemic settings, negative microbiology does not exclude CNS/disseminated TB in immunosuppressed patients, and that HRCT chest can be pivotal when CNS and sputum studies are non-contributory.

Keywords: tuberculoma, multiple ring-enhancing lesions, CNS tuberculosis, disseminated tuberculosis, RPGN, cyclophosphamide, immunosuppression, smear-negative tuberculosis, endobronchial spread, empirical ATT

How to Cite?: Dr. Amrutha P, Dr. Ravishankar S N, Dr. Bharath D S, "Beyond Negative Microbiology: Disseminated Tuberculosis with Multiple Cerebral Tuberculomas in an Immunosuppressed Patient", Volume 15 Issue 7, July 2026, International Journal of Science and Research (IJSR), Pages: 2191-2193, https://www.ijsr.net/getabstract.php?paperid=SR26726191029, DOI: https://dx.doi.org/10.21275/SR26726191029

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