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.