A sky full of stars can be breathtaking—even in a hospital emergency room.
However, instead of stars, doctors in South Korea were examining bright brain lesions on a magnetic resonance imaging (MRI) scan. This distinct pattern was known as a “starry sky,” indicating that their 57-year-old patient was suffering from a severe type of tuberculosis. The doctors detailed this case in the latest issue of the New England Journal of Medicine.
The man had previously undergone treatment for lung infection but arrived at the emergency department after experiencing two weeks of unexplained headaches, neck pain, and tingling in his right hand. The MRI and Computed-Tomography (CT) scans revealed significant issues: rare nodules and lesions, referred to as tuberculomas, scattered across his lungs and central nervous system, affecting both cerebral hemispheres, the basal ganglia, the back of the brain (cerebellum), brain stem, and upper spinal cord.
The condition, termed CNS tuberculoma, is an uncommon form of tuberculosis that usually targets the lungs but can also affect other body parts. It remains unclear how exactly tuberculomas develop, but indications show that the tuberculosis-causing bacteria—Mycobacterium tuberculosis—may spread through the bloodstream. This bacterium could potentially cross the blood-brain barrier by disguising itself within a type of white blood cell called a macrophage or by penetrating the barrier directly. Tuberculomas are believed to arise when these bacteria, along with macrophages, aggregate into masses that may contain calcifications or caseum, a cheese-like dead tissue.
