CEREBRAL TUBERCULOSIS PRESENTING AS COMPLEX FEBRILE CONVULSIONS

Complex febrile convulsions were the initial clinical manifestation of miliary tuberculosis in a 4-year-old immigrant girl. The cerebral les ions were visible only after contrast-enhanced cranial computed tomogr aphy (CT) while native CT scan as well as cell count and glucose conce ntration in the cerebrospinal fluid were normal. Mycobacterium tubercu losis was cultured from gastric aspirate and liver biopsy tissue. Trea tment with isoniazid and rifampin for 12 months, pyrazinamide for 9 mo nths, and ethambutol for the initial 6 weeks resulted in resolution of the cerebral lesions but a retinal scar after granuloma formation in the right eye caused reduced visus. This case demonstrates the importa nce of thorough search for tuberculosis even in the absence of overt c linical pulmonary signs especially in high-risk individuals such as im migrants.