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Journal of Pediatric Neurology
DOI: 10.1055/s-0044-1782542
Case Report

A Middle-Aged Patient Living with HIV (PLHIV), Presented with Persistent Hiccups, Imbalance, and Multifocal Myoclonus Secondary to Disseminated Tuberculosis

Tushar Ashok Vidhale 
1   Department of Medicine, Grant Government Medical College and JJ Group of Hospitals, Byculla, Mumbai, Maharashtra, India
,
Rohan Prafulla Jaya
2   Department of Radiology, BGS Global Institute of Medical Sciences, Bangalore, Karnataka, India
,
Minal Pande
1   Department of Medicine, Grant Government Medical College and JJ Group of Hospitals, Byculla, Mumbai, Maharashtra, India
,
Mohammad Arfat Ganiyani
1   Department of Medicine, Grant Government Medical College and JJ Group of Hospitals, Byculla, Mumbai, Maharashtra, India
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Abstract

A middle aged male presented with chronic diarrhoea, persistent hiccups and unsteadiness while walking. His illness had subacute onset and progressive course. Clinically patient had cachexia, pallor, oral thrush and hepatosplenomegaly. On neurological examination, he had fine tremors, gait ataxia, and multifocal myoclonus. Investigations revealed normochromic normocytic anemia, transaminitis, hyponatremia and cerebrospinal fluid pleocytosis(lymphocytic predominance). Brain MRI revealed diffuse patchy meningeal enhancement; CECT abdomen showed circumferential bowel wall thickening, hepatosplenomegaly and necrotic lymphadenopathy. CECT chest exhibited mediastinal lymphadenopathy alongwith centrilobular nodular opacities. Sputum GeneXpert® was positive for mycobacterium tuberculosis with sensitivity to rifampicin. His serology for human immunodeficiency virus was positive. He was diagnosed as disseminated tuberculosis with tuberculer meningitis which caused persistent hiccups, gait abnormaliy and multifocal myoclonus. His symptom resolved with anti tubercular therapy. We aim to highlight here that myoclonus is a rare occurrence with tubercular meningitis.

Keywords

tuberculous meningitis - disseminated tuberculosis - hiccups - multifocal myoclonus


Publication History

Received: 03 July 2023

Accepted: 02 January 2024

Article published online:
10 July 2024

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