PULMONARY AND CENTRAL-NERVOUS-SYSTEM TUBERCULOSIS IN AN INFANT

A 19 months old male child was hospitalized, because of recurring fever and a sudden cranial nerve palsy (sixth nerve). The chest roentgenogram showed miliary tuberculosis. Magnetic resonance imaging (MRI) of the brain revealed disseminated tuberculous granulomas and vasculitis/perivasculitis without meningitis in the basal cisterns. In spite of immediate antituberculous chemotherapy the child developed additional leftsided hemiparesis and peripheral facial palsy. Control MRI of the brain on day 13, showed a new lesion in the right external capsule consistent with this hemiparesis. Within 2 months cranial nerve palsy VI and VII completely disappeared, whereas spastic hemiparesis of the left side is still present. Since the withdrawal of TB vaccination of all newborns in Austria in 1989 central nervous system tuberculosis should be taken into consideration more frequently when dealing with prolonged illness of unknown origin in infancy and early childhood.