PULMONARY AND CENTRAL-NERVOUS-SYSTEM TUBE RCULOSIS IN AN INFANT

A 19 months old male child was hospitalized, because of recurring feve r and a sudden cranial nerve palsy (sixth nerve). The chest roentgenog ram showed miliary tuberculosis. Magnetic resonance imaging (MRI) of t he brain revealed disseminated tuberculous granulomas and vasculitis/p erivasculitis without meningitis in the basal cisterns. In spite of im mediate antituberculous chemotherapy the child developed additional le ftsided hemiparesis and peripheral facial palsy. Control MRI of the br ain on day 13, showed a new lesion in the right external capsule consi stent with this hemiparesis. Within 2 months cranial nerve palsy VI an d VII completely disappeared, whereas spastic hemiparesis of the left side is still present. Since the withdrawal of TB vaccination of all n ewborns in Austria in 1989 central nervous system tuberculosis should be taken into consideration more frequently when dealing with prolonge d illness of unknown origin in infancy and early childhood.