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.