ANSWER
The bronchoscopy indicates an obstruction of the right upper lobe with
granulation tissue .
OTHER RESULTS:
Immunoglobulins: normal
BAL:
–
PCR for Mycobacterium Tuberculosis Complex: Positive
–
Smear for a Acid Fast bacilli +
–
Mycobacterium culture - results pending
–
CSF: normal
She was started on Isoniazid, Pyrazinamide and Rifampin after the result
of PCR on the 4th day of admission. Ethambutol was started by the infectious
disease service later on because the AFB was not yet identified as Mycobacterium
Tuberculosis and Ethambutol has better activity against atypical mycobacteria
than streptomycin. However, the possible side effect of optic neuritis
should considered. At time of discharge, as the diagnosis of TB was
confirmed, ethambutol was discontinued.
She developed a generalized convulsion and was admitted to the ICU and
intubated. She had a cranial MRI which showed a right middle cerebral
artery infarction.
DIAGNOSIS
Nine-month-old female with miliary TB and central nervous system involvement,
resulting in aright temporal lobe stroke.
FOLLOW-UP
She was seen in Pulmonary and neurology clinics after one month. She
has significant recovery, but there was some evidence of gross motor
delay and there was mild truncal hypertonia, particularly affecting
her lower limbs. She did not have any more seizures. Respiratory symptoms
were absent. She is now taking : isoniazid, rifampicin , pyrazinamide,
phenobarbitol and vitamin B6.
After considerable searching, the contact has been traced with an adult local resident in her home town. The present plan is to book her for a visual evoked response and repeat the MRI .
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