Grand Rounds

Starry Sky Intracranial Granulomas with Spinal Granulomas

Tsering Yangchen1, Ira Shah2
1Seth G S Medical College, Mumbai, India and Pediatric Infectious Diseases, Levioza Health Care, Mumbai, India, 2

Address for Correspondence: Tsering Yangchen, Seth G S Medical College, Mumbai, India. Email:

Clinical Problem:
An 8 years old female, presented in Feb 2015 with fever and headache for 15 days. She was admitted in a hospital a week ago after she developed right lateral rectus palsy. There was no contact with a patient having TB. CT brain showed nodular area with surrounding hypodensity in left anterior gangliocapsular region. MRI brain showed granulomas in cerebral, cerebellar hemispheres and brain stem along with moderate obstructive hydrocephalus with meningeal enhancement like a starry sky appearance (Figure 1). The lesions were hyperintense on T1 and hypointense on T2 and Flair. There were also spinal granulomas. (Figure 2) X-Ray chest was normal, Mantoux test was negative and Dengue IgM positive. Cerebrospinal fluid (CSF) was cloudy with 800 cells (95% polymorphs and 5% lymphocytes), proteins 42 mg/dl glucose 27mg/dl with corresponding blood sugar of 135mg/dl. CSF geneXpert was negative for Mycobacterium tuberculosis (MTB). HIV Elisa was negative. On examination, weight was 16.5 kg, she had meningeal signs and right lateral rectus palsy.

What is the likely diagnosis?

Previous Grand Rounds View All

A Queer Case of Thrombocytopenia in a Child
Govind Kendre, Shruti Mantri, Sunil Hilalpure, Suraj Goyanka, Leo Prince, Murlidharan C
A 3-years-old male child was hospitalized for right-sided pneumonia. Complete blood count (CBC) showed hemoglobin 13.5 gm/dl, total leucocyte count- 6800 cells/cumm and thrombocytopenia with a platele....
Is it Ehlers Danlos syndrome or Osteogenesis Imperfecta?
Devi Bavishi, Ira Shah, Ashok Johari
A two and a half years old female, born of a non-consanguineous marriage presented in August 2011 with multiple fractures affecting all limbs since the age of nine months. She had 36 fractures till da....
Crohn's disease or intestinal tuberculosis: A diagnostic dilemma
Amit Dashputra, Ira Shah
A 12-year-old boy presented with pain in the abdomen for 5 months and a weight loss of 18 kg in the same period. He used to pass non-bloody loose stools with mucus 2-3 times a day. The examination sho....
Growth of Mycobacterium tuberculosis (MTB) on Sputum Culture in an Asymptomatic Child
Amit Dashputra, Ira Shah
A 6-year-old female was referred to us for evaluation of incidentally discovered right-sided cervical lymphadenopathy for one month. She had a cough initially for a week but now did not have any compl....
Fever with rash over palms and soles along with hepatomegaly - Can it be parvovirus infection?
Amit Dashputra, Ira Shah
A 4-year-old female presented with fever for 5 days. She had red eyes along with fever for the initial 2 days. Subsequently, she developed rash over palms and soles after 2 days of fever, which had re....
Disclaimer: The information given by is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0