Cerebral Infarction as the First Presentation of Tuberculosis in an Infant: A Case Report

The case of a child admitted to hospital with acute onset of hemiparesis and seizure is presented. Extensive evaluation of an acute ischemic event in the form of a brain infarct found on brain magnetic resonance imaging was inconclusive. Two months later, the patient was referred with severe hydrocephalus, which was managed with ventriculoperitoneal shunting in the presence of normal ventricular cerebrospinal fluid. The shunt was complicated by distal end infection. During the insertion of a second shunt, and after 3 months of antibiotic therapy, peritoneal thickening was found. Peritoneal biopsy showed evidence of a granulomatous reaction. This finding, along with positive polymerase chain reaction of the cerebrospinal fluid, confirmed tuberculosis. The patient recovered from most of his symptoms after antituberculous therapy, and a new ventriculoperitoneal shunt was inserted. This is a very peculiar presentation of tuberculosis that began with a cerebral infarction due to vasculopathy and hydrocephalus without any constitutional symptoms, and was later confirmed by peritoneal pathology.