Multifocal tuberculosis with cerebral, spinal, pulmonary and abdominal involvement in a 16-year-old girl: A radiological case report

Multifocal tuberculosis involving the central nervous system and systemic organs is uncommon but well documented, particularly in endemic regions and in the setting of incomplete treatment. We report the case of a 16-year-old girl with prior pulmonary tuberculosis and poor therapeutic adherence who presented with progressive paraparesis over 3 weeks. Brain Magnetic resonance imaging demonstrated multiple supratentorial enhancing lesions consistent with solid granulomatous tuberculomas, without significant surrounding edema. Associated leptomeningeal and pachymeningeal enhancement was also observed. Spinal Magnetic resonance imaging revealed longitudinally extensive transverse myelitis extending from T3 to the conus medullaris with intramedullary T2 hyperintensity. In addition, a lumbar posterior epidural collection (from L2 to L4) causing thecal sac compression was identified. Chest CT showed a tree-in-bud pattern consistent with active pulmonary tuberculosis. Abdominal CT demonstrated enlarged abdominal lymph nodes with central low attenuation and a perihepatic collection. Tuberculosis was confirmed by positive cerebrospinal fluid Polymerase chain reaction for Mycobacterium tuberculosis . The patient underwent appropriate management including decompression and reinitiation of antituberculous therapy, with partial neurological improvement on follow-up. This case illustrates the imaging spectrum of disseminated tuberculosis with simultaneous parenchymal, meningeal, spinal cord, and epidural involvement, emphasizing the importance of multimodal imaging evaluation.