Disseminated Tuberculosis Presenting as Cerebellar Dysfunction and Adrenal Insufficiency in an Immunocompetent Patient: A Rare Coexistence

Disseminated tuberculosis is more prevalent in immunocompromised hosts; however, it can affect people with intact immune systems. Here, we present a case of an immunocompetent young woman who presented with headache, vomiting, and dizziness for the past two months. There was a history of significant weight loss during this period. Examination revealed postural hypotension and positive cerebellar signs. Imaging of the brain revealed a conglomerate mass in the cerebellar vermis suggestive of tuberculoma. Tubercle bacilli were detected in gastric lavage specimens. Laboratory investigations revealed hyponatremia with low serum osmolality. Further investigations showed low serum cortisol and high adrenocorticotrophic hormone levels. CT of the abdomen revealed atrophy of both adrenal glands. Our patient was diagnosed with cerebellar dysfunction and adrenal insufficiency secondary to disseminated tuberculosis. We started the patient on antituberculous drugs, along with mineralocorticoid and glucocorticoid replacement. Subsequent follow-up showed significant improvement in symptoms. Hence, timely diagnosis of the disease is essential to prevent lethal outcomes.