case_images: PMC11822684_01
case_images: Sequential magnetic resonance imaging (MRI) of the brain fluid attenuation recovery sequence (FLAIR) (A-D) and T2-weighted imaging sequence (E-H) showing dilated bilateral lateral ventricles (orange arrows), third ventricle (blue arrows) with periventricular oozing and non-dilated fourth ventricle (green arrows) with T2/FLAIR hyperintense debris in the peri-mesencephalic cisterns (black arrows) suggesting extraventricular obstructive hydrocephalus caused by tubercular debris.
case_images: fmed-12-1507511-g001.jpg
case_images: PMC11822684_01_fmed-12-1507511-g001.jpg
case_images: fig1
case_images: Magnetic resonance imaging (MRI) of the cervical spine in the sagittal section showing longitudinal extensive midline hyperintense lesions on T2-weighted imaging in both the upper and lower cervical spinal cord, suggestive of long-segment cervical cord myelitis with associated cord oedema.
case_images: fmed-12-1507511-g002.jpg
case_images: PMC11822684_01_fmed-12-1507511-g002.jpg
case_images: fig2
case_images: This revealed longitudinal, extensive midline hyperintense lesions on T2-weighted imaging in both the upper and lower cervical spinal cord, suggestive of long-segment cervical cord myelitis with associated cord oedema as shown in Figure 2.
case_images: (A) Anteroposterior chest X-ray showing multiple homogeneous small nodular opacities in both lung fields, suggesting the presence of miliary mottling. (B) High-resolution computed tomography (HRCT) thorax picture showing the snowstorm appearance of miliary mottling as shown in the X-ray.
case_images: fmed-12-1507511-g003.jpg
case_images: PMC11822684_01_fmed-12-1507511-g003.jpg
case_images: fig3
case_images: A bedside chest X-ray was performed as the history of the patient was highly suggestive of tuberculosis along with a positive respiration system examination, which revealed diffuse fine homogeneous opacities in both lung fields suggestive of miliary mottling as shown in Figure 3A and a high-resolution computed tomography (HRCT) thorax was also performed, which revealed snowstorm appearance of miliary mottling as shown in Figure 3B.
case_images: Sputum microscopy showing multiple rod-like bacilli with acid-fast bacilli (AFB) grade-III growth on direct Ziehl Neelsen (ZN) stain microscopy.
case_images: fmed-12-1507511-g004.jpg
case_images: PMC11822684_01_fmed-12-1507511-g004.jpg
case_images: fig4
case_images: Multiple rod-like bacilli were present in the sputum Ziehl Neelsen (ZN) stain microscopy with grade-III growth of bacilli, as shown in the microscopic slide picture in Figure 4, which helped confirm the diagnosis of tubercular aetiology of meningitis and tuberculous myelitis, with a positive cartridge-based nucleic acid amplification test (CBNAAT) profile for tuberculosis.