The patient subsequently underwent a workup for Tuberculosis.

A lumbar puncture was performed and geneeXpert testing was positive for TB from the CSF sample.

An MRI spine was attempted, but due to pain a limited study was completed. There was no obvious leptomeningeal enhancement on the selected sequences. A CT chest found bilateral extensive tree in bud nodularity.

The patient was commenced on high dose HRZE for a consideration of TB meningitis. He recovered well with an improvement in neurology before discharging home for continued treatment.

This is an interesting case in that the patient's admission months prior (to another center) for cough, shortness of breath and weight loss (13 kg) was the likely commencement of TB activation. This patient was not from a high risk population and not born in an endemic region.