Case Report
A 50-year-old man visited the emergency unit with slurred speech, difficulty swallowing, and involuntary movements of the right upper extremity. Prior to complaints of involuntary movement of upper limb, the patient complained of vomiting due to a hot and pressure-like feeling on his throat. Then, he complained of slurred speech and difficulty swallowing. These complaints appeared an hour and a half before arriving at the hospital. All complaints disappeared as soon as he arrived at the hospital. The patient also complained of numbness of the right hand since one month before arrival. However, there were no complaints of fever, headache, or cough. The patient had a history of hospitalization 6 months before with dizziness. His next house neighbour was reported having cough for months but the cause was unknown.
Based on physical examination, the patient was found to be compos mentis. The patient has a temperature of 36.1oC, pulse of 112 beats/minute, respiratory rate of 22 breaths/minute, blood pressure of 149/81 mm/Hg., and oxygen saturation of 96%. The patient had a fever with a temperature of 38.0oC on the first night of hospitalization, then the temperature immediately return to normal after receiving paracetamol. He has no neck stiffness but has bilateral cervical lymphadenitis. Based on neurological examination, numbness was found in the patient’s right palm. The result of cranial nerves and motor examinations were normal.
Further, computed tomography (CT) scan of the head showed a hypodense lesion in the left parietal lobe (Fig.1). The chest radiograph showed peribronchial and parenchymal infiltrates (Fig. 2). Laboratory tests showed a positive HIV antibody test. Cervical lymph node biopsy showed the presence of cheese granulomatous inflammation and positive acid-fast bacilli.