CASE PRESENTATION:
A 74-year-old man presented to the emergency department with decreased
consciousness and weakness in both lower limbs for about 6 hours for
which he was brought to the emergency department. The patient had a
history of recurrent urinary retention, but no fever or weight loss. He
had a smoking history of 25 pack-years and was a non-alcoholic. The
patient had a past medical history of pulmonary tuberculosis, which was
successfully treated with antitubercular drugs under Directly Observed
Treatment Short-course (DOTS) 15 years ago.
On examination, the patient was thin build and oriented to place but not
to time and person. Chest examination revealed bilateral scattered
wheeze over most of the lung fields, with bronchial breath sounds heard
over the right upper lung region. Neurological examination showed
bilateral lower limb weakness (power of 3/5) with intact sensations.
Abdominal examination revealed a palpable bladder that was slightly
tender. Other examinations were unremarkable. Bedside glucometer
measurements indicated normal blood glucose levels.
Emergency blood investigations (Table 1 ) revealed severe
hyponatremia and an elevated erythrocyte sedimentation rate (ESR). A
computed tomography (CT) head scan was performed to rule out stroke,
which showed age-related cortical atrophy. Magnetic resonance (MR) spine
imaging showed normal findings. Chest X-ray revealed areas of fibrosis
(Figure 1 ). Sputum samples were collected for Ziehl-Neelsen
(ZN) stain and Gram stain examinations, which yielded normal results.
GeneXpert testing on the sputum samples detected a low amount ofMycobacterial Tuberculosis . Further, Line Probe Assay (LPA) was
conducted for drug susceptibility testing which didn’t show resistance
to Isoniazid and Rifampicin.