I've always thought of tuberculosis as a disease of the lungs. I won't pretend that it's because of La Traviata and her persistent coughing which punctuates Puccini's work. Even after three and half years of medical school, I couldn't help associating TB with coughing, weight loss and a few other symptoms.
Of course, this isn't wrong: the lungs certainly are a site of predilection for Mycobacterium tuberculosis. It likes to set up camp there and hibernate for years, sometimes a whole lifetime. But despite this affinity for the draughty recesses of the chest, TB also enjoys going for a wander elsewhere. The spine, the kidneys, the eyes: no sites are really off limits for this bacterium if the conditions are right.
The conditions are definitely right in this patient. He contracted HIV many years ago and has not been receiving any antiretrovirals. Slowly, but surely, the virus has gained the upper hand over his immune system. Today, his body is essentially a very badly defended shelter for whichever micro-organism might choose to invade.
He came in to the hospital because he was having difficulty walking. On examination, he is weak all along his right-hand side. He has swollen lymph nodes throughout his body, along with headaches and fever. This picture is typical for toxoplasmosis, but the doctors here are convinced it will turn out to be TB in the brain. There's so much of the disease around, the investigations will probably prove them right.
A few weeks ago I would never have associated TB with hemiplegia, particularly if the patient didn't have any chest symptoms. Perhaps someone could have guided me there with some leading questions, but the two things just weren't linked in my mind. Having now seen nearly a dozen cases of TB meningitis, I'm starting to realise that most things could be due to this disease.
Of course, this isn't wrong: the lungs certainly are a site of predilection for Mycobacterium tuberculosis. It likes to set up camp there and hibernate for years, sometimes a whole lifetime. But despite this affinity for the draughty recesses of the chest, TB also enjoys going for a wander elsewhere. The spine, the kidneys, the eyes: no sites are really off limits for this bacterium if the conditions are right.
The conditions are definitely right in this patient. He contracted HIV many years ago and has not been receiving any antiretrovirals. Slowly, but surely, the virus has gained the upper hand over his immune system. Today, his body is essentially a very badly defended shelter for whichever micro-organism might choose to invade.
He came in to the hospital because he was having difficulty walking. On examination, he is weak all along his right-hand side. He has swollen lymph nodes throughout his body, along with headaches and fever. This picture is typical for toxoplasmosis, but the doctors here are convinced it will turn out to be TB in the brain. There's so much of the disease around, the investigations will probably prove them right.
A few weeks ago I would never have associated TB with hemiplegia, particularly if the patient didn't have any chest symptoms. Perhaps someone could have guided me there with some leading questions, but the two things just weren't linked in my mind. Having now seen nearly a dozen cases of TB meningitis, I'm starting to realise that most things could be due to this disease.
No comments:
Post a Comment