Batool Wajeeha, Khan Sulhera, Naveed Shabnam, Ahmad Syed Masroor
Department of Internal Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK.
Department of Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK.
Cureus. 2022 Oct 21;14(10):e30551. doi: 10.7759/cureus.30551. eCollection 2022 Oct.
Disseminated tuberculosis is more prevalent in immunocompromised hosts; however, it can affect people with intact immune systems. Here, we present a case of an immunocompetent young woman who presented with headache, vomiting, and dizziness for the past two months. There was a history of significant weight loss during this period. Examination revealed postural hypotension and positive cerebellar signs. Imaging of the brain revealed a conglomerate mass in the cerebellar vermis suggestive of tuberculoma. Tubercle bacilli were detected in gastric lavage specimens. Laboratory investigations revealed hyponatremia with low serum osmolality. Further investigations showed low serum cortisol and high adrenocorticotrophic hormone levels. CT of the abdomen revealed atrophy of both adrenal glands. Our patient was diagnosed with cerebellar dysfunction and adrenal insufficiency secondary to disseminated tuberculosis. We started the patient on antituberculous drugs, along with mineralocorticoid and glucocorticoid replacement. Subsequent follow-up showed significant improvement in symptoms. Hence, timely diagnosis of the disease is essential to prevent lethal outcomes.
播散性结核病在免疫功能低下的宿主中更为常见；然而，它也可影响免疫系统正常的人。在此，我们报告一例免疫功能正常的年轻女性病例，该患者在过去两个月出现头痛、呕吐和头晕。在此期间有明显体重减轻史。检查发现体位性低血压和小脑征阳性。脑部影像学检查显示小脑蚓部有一个团块，提示结核瘤。在洗胃标本中检测到结核杆菌。实验室检查显示低钠血症伴血清渗透压降低。进一步检查显示血清皮质醇水平低，促肾上腺皮质激素水平高。腹部CT显示双侧肾上腺萎缩。我们的患者被诊断为继发于播散性结核病的小脑功能障碍和肾上腺功能不全。我们开始给患者使用抗结核药物，同时进行盐皮质激素和糖皮质激素替代治疗。随后的随访显示症状有显著改善。因此，及时诊断该病对于预防致命后果至关重要。
