Cerebral Manifestation of Miliary Tuberculosis Mimicking a Parasitic CNS Infection

The neuroradiological findings of central nervous system (CNS) manifestations of miliary tuberculosis can be misinterpreted as parasitic infections due to their low prevalence in the European population. We present the case of a 30-year-old woman in whom CNS tuberculosis was initially misdiagnosed as a parasitic infection due to the absence of pulmonary symptoms. She immigrated to Germany from Madagascar and had lived in Europe for 14 months by the time she presented to our department with an incidental MRI finding suggestive of a manifestation of toxoplasmosis. The T1-weighted axial brain MRI scan revealed multifocal, rim-enhancing lesions that were suggestive of parasitic infection. Following a chest CT scan that revealed miliary tuberculosis, the diagnosis was revised to neurotuberculosis. This was confirmed by a polymerase chain reaction (PCR) that detected the Mycobacterium tuberculosis complex in the sputum sample. The patient achieved remission following 12 months of antituberculosis therapy. In conclusion, neurotuberculosis should be considered in the differential diagnosis of infections presenting with multifocal CNS manifestations on neuroimaging scans in European patients, particularly those with a migration background.