Table 1.
Investigations and findings
| Serial number | Investigations | Results or findings |
|---|---|---|
| 1 | Complete blood count | WBC 13.9 × 103 Red blood cell count 4.4 × 103 Platelet count 278 × 103 Hematocrit 10 g/dl |
| 2 | Urinalysis | pH 6 Specific gravity 1.020 Negative for ketone and glucose WBC 2–5/HPF Negative for chemical tests (leukocyte esterase, nitrite, urobilinogen, protein) |
| 3 | Liver function tests | AST/SGOT (aspartate transaminases) 92U/L SGPT/ALT (alanine aminotransferase) 40U/L ALP (alkaline phosphatase) 100IU/L |
| 4 | Renal function test | Creatinine 0.5mg/dl |
| 5 | HIV | Negative antibody test |
| 4 | Erythrocyte sedimentation rate in first hour | 65 mm/hr |
| 2 | Cerebrospinal fluid analysis | 105 cells (65 lymphocytes) No organism on Gram stain and acid-fast bacilli stain |
| 3 | Chest x-ray | Right upper and middle lobe ill-defined airspace opacity |
| 4 | Skin discharge analysis | Gram-positive diplococci in chain on Gram stain, Mycobacterium tuberculosis on Xpert MTB/RIF assay |
| 5 | Fine-needle aspiration cytology | Only caseous necrosis, no granuloma, and smears from ulcerated lesions show mixed inflammatory cells, predominantly polymorphs |
| 6 | Skin biopsy | Tuberculous scrofuloderma: with section showing mature squamous cell-lined skin tissue composed of epithelioid cell granuloma, multinucleated giant cells, caseous necrosis, and mixed inflammatory cells |
| 7 | Brain computed tomography | Multiple precontrast hyperdense randomly distributed supra- and infratentorial lesions with mild perilesional edema. Rim enhancement on postcontrast image (caseating granulomas) on some lesions and solid pattern of enhancement (noncaseating granulomas) evident on others. Dense basal cistern exudate seen on precontrast images with avid postcontrast basal leptomeningeal enhancement. Severe bilateral lateral, third- and fourth-ventricle dilation was noted. |
Abbreviations: HIV Human immunodeficiency virus, HPF High-power field, Xpert MTB/RIF Automated real-time nucleic acid amplification technology used for rapid and simultaneous detection of tuberculosis and rifampicin resistance, WBC White blood cell