Tuberculosis (TB) may affect the nervous system in many ways. We describe an immunocompetent teenage girl with lymph node TB who had first presented with bilateral optic neuritis. Detailed history identified features inconsistent with immune-mediated optic neuritis. Several unusual features prompted further investigation, including transient visual obscurations without raised intracranial pressure, prominent disc swelling and absence of laboratory findings to support an immune-mediated cause. Whole body PET/MR imaging identified widespread mediastinal and supraclavicular lymphadenopathy. Despite no known TB contacts, a negative interferon gamma release assay and a normal chest X-ray, a targeted lymph node biopsy confirmed TB.

中文翻译：

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双侧视神经炎是淋巴结结核的首发表现

结核病 (TB) 可能以多种方式影响神经系统。我们描述了一名患有淋巴结结核的免疫功能正常的少女，她首次出现双侧视神经炎。详细的病史确定了与免疫介导的视神经炎不一致的特征。一些不寻常的特征促使进一步调查，包括没有颅内压升高的短暂视觉障碍、显着的椎间盘肿胀和缺乏支持免疫介导原因的实验室检查结果。全身 PET/MR 成像发现广泛的纵隔和锁骨上淋巴结肿大。尽管没有已知的结核病接触者、干扰素 γ 释放试验阴性和胸部 X 光检查正常，但靶向淋巴结活检证实了结核病。