Kauvey Kathaigal: 5
The Great Mimicker Unmasked: A young boy’s journey through Disseminated TB
Case at a Glance
A young boy had a sudden onset of fever followed by a generalized tonic clonic seizure. He also had swollen left cervical lymph nodes (neck), enlarged liver and spleen (hepatosplenomegaly).
Key Diagnostics: MRI revealed multiple ring-enhancing lesions in the brain; elevated ESR/CRP (indicating inflammation).
Working Diagnosis: Disseminated Tuberculosis (Extrapulmonary TB involving the brain, lymph nodes, and abdomen).
Patient Story
A young boy’s life was suddenly interrupted by a high fever and an alarming seizure. The family was thus thrust into a medical emergency. While the seizure was the most alarming symptom, it was merely the “smoke” from a fire that had been quietly spreading through his body.
Upon examination, the clues began to surface: a cluster of “matted” lymph nodes in his neck and an enlarged liver and spleen suggested a systemic invader. While his brain MRI showed multiple ring-enhancing lesions, it was the clinical picture of anemia and high inflammatory markers that pointed toward a familiar but formidable foe. The boy wasn’t just battling an isolated neurological event; he was fighting a widespread infection by Tuberculosis; TB had traveled from his primary systems into the very architecture of his brain, creating Tuberculomas
Treatment plan
While waiting for the definitive lymph node biopsy results, a robust anti-tubercular strategy was initiated because MTB RT -PCR test detected Mycobacterium Tuberculosis Complex (very low), with indeterminate rifampicin resistance., in his Lymph node tissue
Antitubercular Therapy (ATT): A specialized four-drug regimen (HRZE) to penetrate the blood-brain barrier and begin shrinking the intracranial lesions.
Seizure Control: Administration of anti-convulsivec medication to stabilize the brain’s electrical activity while the lesions heal.
Steroid Adjunct: A course of corticosteroids to reduce the “perifocal edema” (swelling) around the brain lesions, preventing further neurological damage
Outcome and Follow-up
Lymph node biopsy showed epithelioid granulomatous lymphadenitis with small foci of necrosis. Ziehl-neelsen acid fast stain showed positivity for Tb bacteria. With the initiation of the 2025 standard TB protocols, the boy’s fever subsided within the first two weeks.
As the inflammation decreased, his appetite returned, and the matted nodes in his neck began to soften and shrink. Follow-up imaging is scheduled to track the regression of the ring-enhancing lesions. Because the brain was involved, his treatment will be a long-haul journey—likely 9 to 12 months—to ensure every trace of the infection is eradicated.
Conclusion
This case highlights that TB remains a “Great Mimicker.” In a young child, a seizure can be the first overt sign of spread of a disease to the brain that has already quietly established itself in the lymph nodes and abdomen. Success in these cases relies on looking past the brain symptoms to find the systemic clues—like the matted neck nodes—that reveal the true nature of the illness.
"Treat the root cause, not just the symptoms"
