The patient went on to have a lumbar puncture which confirmed the diagnosis of tuberculosis (see below). Specifically, the presence of low T2 signal, absent diffusion restriction are in keeping with a diagnosis of tuberculomas rather than tuberculous abscesses. 

The patient was commenced on antimycobacterial therapy. 

Lumbar puncture

MICROSCOPIC DESCRIPTION:

The smears contain moderate numbers of lymphocytes, monocytes, neutrophils, eosinophils, plasma cells and red blood cells. There are no granulomas. No microorganisms are seen in the Giemsa stain. No malignant cells are identified. DIAGNOSIS: Cerebrospinal fluid: Active inflammation.

CSF CELL COUNT:

• Erythrocytes 10 x10^6/L
• Polymorphs 11 x10^6/L
• Lymphocytes 42 x10^6/L

GRAM STAIN:

• No organisms seen.

ANTIGEN TESTING MPT64: 

• M.tuberculosis Complex DETECTED

NUCLEIC ACID TESTING Mycobacterium Sp. by DNA Probe:

• Positive for Mycobacterium tuberculosis

MYCOBACTERIUM CULTURE SCREEN MGIT bottle:

• Positive (<16 days). Mycobacterium tuberculosis isolated. 

INDIAN INK PREPARATION:

• Encapsulated yeasts NOT Detected

CRYPTOCOCCAL SEROLOGY:

• Cryptococcal Ag: NOT Detected