Brain tuberculomas mimicking intracranial metastasis in a patient presenting with fits

Brain tuberculosis is still prevalent in many developing countries, especially Asian countries. Tuberculomas should always be considered in the differential diagnosis of enhancing intra-axial lesions of the brain. Brain tuberculomas can present in many different clinical and radiological patterns clinically like headache, fits, cranial nerve palsies and very rarely as brain tuberculomas. We describe the case of a 48 years old male patient presenting with persistent headache and fits, referred for workup of brain metastasis or primary brain neoplasm. On further imaging, it turned out to be multiple tuberculomas of brain which resolved on anti-tuberculous treatment along with symptoms relief

Mediastinal tuberculosis presenting with sternal osteomyelitis and discharging sinus

Involvement of the mediastinum and sternal bone leading to osteomyelitis is a very rare presentation of tuberculosis even in countries where tuberculosis is endemic like Pakistan. Frank presentation as discharging sinus is even more uncommon. We describe a case where a patient presented with constitutional symptoms of fever, loss of appetite, significant weight loss and an erythematous tender lesion over the sternum with a discharging sinus without any features of pulmonary tuberculosis. The case was initially not diagnosed by routine laboratory tests and the lesion was just considered as a boil until presented to tertiary care hospital as discharging sinus. Plain Radiographs showed lytic lesion on the inner aspect of sternum and histopathology of the aspirate from the lesion confirmed the presence of epithelioid granulomas and acid fast bacilli on staining. Patient responded very well to 12 months of antituberculosis treatment