Disseminated tuberculosis with symptoms of decreased consciousness: A rare case in Indonesian male

Background: Disseminated tuberculosis is a rare case that causes high mortality and morbidity.

Case presentation: A 59-year-old man with a glasgow coma scale of 12, cerebrospinal fluid was found to have dominant mononuclear, high protein level, low glucose level and shortness of breath. A chest X-ray revealed a right pleural effusion with infiltrates in both lung parenchyma and a pleural fluid adenosine deaminase (ADA) test showed 66.1 U/L. Thoracolumbar MRI revealed a compression fracture in the 6th thoracic vertebral body. The patient was given category 1 anti-tuberculosis drug (ATD) therapy plus streptomycin and dexamethasone and water seal drainage (WSD) was installed. The patient experienced improvement after taking ATD after 4 months in which the patient could stand and walk by using an object in front of him.

Discussion: Accurate and prompt diagnosis of disseminated tuberculosis minimizes patient's mortality and morbidity. Suspicion of tuberculosis can be raised if the patient is experiencing health problems in endemic tuberculosis.

Conclusion: Disseminated tuberculosis (pulmonary tuberculosis, tuberculous pleurisy, tuberculous meningitis, and tuberculous spondylitis) can be managed properly using ATD category 1.