5 Key Takeaways

• 1

  A 30-year-old woman had multiple rim-enhancing brain lesions on routine MRI despite no initial fever, pulmonary symptoms, or neurologic abnormalities.

• 2

  The MRI findings suggested toxoplasmosis or neurocysticercosis, but chest CT showed bilateral 1- to 3-mm pulmonary nodules consistent with miliary tuberculosis.

• 3

  Sputum PCR detected Mycobacterium tuberculosis complex DNA, whereas sputum cultures and CSF tuberculosis PCR were negative and CSF analysis was unremarkable.

• 4

  The researchers diagnosed probable parenchymal CNS tuberculosis with miliary pulmonary tuberculosis and treated the patient with antituberculosis drugs and adjunctive corticosteroids.

• 5

  After 12 months of therapy, brain lesions regressed, and complete clinical and radiologic remission was documented 12 months after treatment.