Miliary Tuberculosis in an Immunocompetent Male with Central Nervous System Involvement

The patient was a 51-year-old male from Mexico with no known significant past medical history who presented with several weeks of intermittent fevers, chills, night sweats, headaches, and weight loss. The headaches, fevers, chills, and night sweats had begun 2 months prior to this admission. One week prior to this admission, he had presented to another institution with a chief complaint of persistent headaches. At the outside hospital, the patient was found to have a positive Quantiferon Gold test. An acid-fast bacilli (AFB) smear collected from the sputum at that institution was negative, and the culture remained negative after 1 week. The patient was then transferred to our hospital for higher level of care. On arrival at our institution, he denied any coughing, shortness of breath, or abdominal pain. His headaches were generalized, and he rated the pain as 9 out of 10. Review of systems was significant for a 20-pound unintentional weight loss over the past 2 months. He moved to the United States from Mexico 30 years ago but had not traveled outside the United States since his last visit to Mexico 15 years ago. There were no known recent exposures to persons with tuberculosis (TB). He denied any known history of TB infection and had never been treated for the disease. Social history was negative for any prison or military history, along with any period of homelessness or drug use. He worked in construction and only endorsed exposure to dust.