Clinical picture New onset seizures and CNS tuberculoma

presented to the emergency room with new onset seizures. He complained of worsening headache for several weeks. He had no cough, fever or weight loss. He immigrated to the USA 7 years ago and his tuberculin skin test was negative at intake. Physical examination revealed a lethargic orally intubated patient. He had stable vital signs. Figure 1. Upper panel is CT scan of the patient’s head showing right frontal lobe ring-enhancing lesion with surrounding edema and midline shift. Lower panel is a hematoxylin and eosin stained biopsy showing multiple granulomas composed of epithelioid histiocytes and multinucleated giant cells. Ziehl–Neelsen staining of the biopsy showed acid-fast bacilli consist-ent with M. tuberculosis