Introduction: Disseminated miliary forms of tuberculoma in brain are rarest form of CNS tuberculosis. It is one of the differential diagnoses of ring enhancing multiple brain lesions. We are reporting an interesting case of 28 year old lady with disseminated tuberculosis with miliary brain tuberculomas. Case presentation: 28 yrs lady with no known previous co-morbidities presented with low grade evening rise in temperature and mild to moderate continues global headache for 10 days associted with nausea and recurrent vomiting, and weight loss of 4 kg. Her ESR, blood count, liver and renal function tests were within normal values. HIV was negative by ELISA. Sputum for Acid Fast bacilli was +3 positive for mycobacterium tuberculosis bacilli. Cerebrospinal Fluid cytological analysis was normal and ADA was 9.1 U/L. Urine microscopic examination was positive for +++ MTB. Chest X ray showed bilateral military opacities. High Resolution CT of Chest was suggestive of miliary distribution of nodules in bilateral lungs. MRI Brain showed discrete ring enhancing lesions scattered in left temporal lobe, and right frontal lobe are located at grey-white matter junctions. In infra- tentorial lesion were at the level of pons, mid brain, inferior cerebellar peduncle and bilateral cerebellar hemispheres. Few of the lesions in right precentral gyrus showing associated mild perilesional edema.Conclusion: Clinician should consider miliary tuberculosis brain in tuberculosis endemic region, in a clinical setting where atypical multiple ring enhancing lesions even with non inflammatory CSF but with presence of other markers of tuberculosis is present.
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