Tuberculosis (TB) is one of major global health threats and leads to morbidity and mortality. TB is prevalent in low and middle income countries especially in Sub-Saharan Africa and South East Asia. M. tuberculosis usually affects the lungs. Spine is the most common extrapulmonary sites for TB after lymph nodes, accounts for 1% of all TB cases, and 50 to 60% of osteoarticular TB. In the case of spinal TB, two or more adjacent vertebrae are usually involved due to hematogenous spread of bacteria in which the vertebral arteries feed the two adjacent vertebrae. The incidence of multiplelevel non-contiguous spinal TB is 1.1 to 16% of all skeletal TB. Multiple-level non-contiguous, an atypical form of spinal TB is rare. It has insidious symptoms, often with diagnostic delays and a higher risk of permanent neurological deficits. We report a case of atypical TB spondylitis with non-contiguous multiple level of lesions mimicking multiple bone metastases.

Background/aim. Mycobacterium tuberculosis (M. tuberculosis) infection can cause pulmonary and extrapulmonary tuberculosis (TB), resulted from hematogenous or lymphatic dissemination of the bacteria. Disseminated TB is characterized by the presence of two or more non-contiguous sites from the spread. Dissemination to the central nervous system (CNS TB) has several manifestations that can cause devastating neurological complications. Several predisposing factors include older age, human immunodeficiency virus (HIV) coinfection, and pharmacological immunosuppression. As the manifestation of CNS TB itself is rare, diagnosing it remains a challenge. Prompt antituberculosis treatment is needed to improve patient’s outcome. This paper aims to present a rare case of malignant disseminated TB in a young immunocompetent patient. Case. This case presents an immunocompetent 17-year-old male with weakness in the four extremities. Through comprehensive history taking and examination, the patient was diagnosed with malignant disseminated TB, presenting as cerebellar tuberculoma, tuberculous meningitis, and multiple skipped level spondylitis TB; and concurrent pulmonary TB. Then, the patient underwent a surgery for the cervical lesion and was started on antituberculosis treatment in combination with corticosteroid. After the treatment, the patient’s motoric and sensoric functions improved and he was able to urinate and defecate normally. Conclusion. This case demonstrates the importance of considering disseminated TB in the differential diagnosis of a patient with neurological deficits, regardless of the fact that the patient is young and immunocompetent. Prompt diagnosis and rapid initiation of treatment can improve the patient’s outcome.

Background and Purpose Guillain-Barre syndrome (GBS) is a common cause of inflammation-related acute flaccid paralysis, and is characterized by acute onset, rapid progression, and symmetrical weakness. GBS is an emergency with high morbidity and long-term disability rates. It is important to determine the prognostic factors for GBS in order to improve the disease outcomes. This study aimed to identify the correlation between the neutrophil-to-lymphocyte ratio (NLR) on day 1 of hospitalization (D1) and motor deterioration in GBS patients. Methods This observational analytical study applied a cross-sectional analysis to the medical records of GBS patients who were hospitalized at Dr. Soetomo General Hospital Surabaya from January 2018 to March 2020. The analysis used the chi-square bivariate test, multivariate analysis with logistic regression, and correlation analysis with the Spearman test. Results The study included 61 subjects. Statistical tests showed that there was no correlation between NLR and changes in the Medical Research Council sum scores (ΔMRC sum scores) during D1–D3, D1–D7, D1–D14, and D1 to the day of discharge ( p >0.05). There was a significant correlation between NLR and the Erasmus GBS outcome score (EGOS) ( p =0.006). NLR values differed significantly within each treatment group ( p =0.001). Therefore, a subanalysis within each treatment group was conducted, which revealed a significant negative correlation ( p <0.05) between NLR and the ΔMRC sum score during D1–D14 in the group treated without immunotherapy. Conclusions There was no correlation between NLR and motor deterioration in patients with GBS during hospitalization. However, NLR was significantly correlated with EGOS, and there was a negative correlation between NLR and motor deterioration during D1–D14 in GBS patients treated without immunotherapy.

Background, aim. Fahr’s disease is a rare neurodegenerative disease caused by intracranial classifications. This case report aims to accentuate the importance of considering rare disease like Fahr’s disease as the differential diagnosis of neuropsychiatric deficits, especially in patients with a history of thyroidectomy. Case presentation. A 50-year-old female who underwent thyroidectomy 5 years previously presented with incoherent speech, behavioral problems, and hand stiffness. On evaluation, several neurobehavioral deficits and carpopedal spasms were observed, along with low Mini-Mental State Examination (MMSE), Hachinski, Activities of Daily Living (ADL), and Instrumental Activities of Daily Living Scale (IADL) score of 22, 4, 13, and 12, respectively. Clinically significant laboratory abnormalities include low serum calcium of 4.7 mg/dl, low thyroid stimulating hormone (TSH) level of 0.113 mIU/l, and low parathyroid hormone (PTH) level of 1.2 pg/ml. In addition, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) reverse transcription-polymerase chain reaction (RT-PCR) test showed a positive result. Meanwhile, brain computerized tomography (CT)-scan results showed multiple bilateral calcifications in the basal ganglia, bilateral cortical-subcortical calcifications in the frontal lobe, and subcortical calcification in the left frontal lobe. Results. The patient was diagnosed with Fahr’s disease secondary to post-thyroidectomy hypoparathyroidism and coronavirus disease 2019 (COVID-19). The patient was treated with calcium lactate, levothyroxine, donepezil, favipiravir for COVID’s infection, vitamin B1, B6, and B12. Conclusions. Fahr’s disease should be considered in patients with neuropsychiatric deficits and spasm disorders, especially in patients with a history of thyroidectomy. Routine follow-up CT-scans after thyroidectomy are recommended.

Background/aim: People with HIV are often reported to experience poor sleep quality. Factors that can cause poor sleep quality in HIV patients, including the use of ARV therapy. The pathophysiology of poor sleep quality in HIV patients is still unclear. Poor sleep quality is one of the complaints in the late stages of HIV infection, where it is suspected that HIV itself affects the biological center of sleep. This study was aimed to determine the comparison of sleep quality in HIV patients pre-HAART and with HAART more than 1 year. Method: This study uses data collection methods in the form of interviews with samples which will later be presented in the form of analytical observational study. Consecutive data collection on HIV patients before and after ARV therapy who was outpatient at the VCT outpatient clinic Dr. Soetomo General Hospital from June-July 2021. Data analysis using SPSS Version 23 for windows. Results: A total of 40 subjects were divided into HIV pre-HAART and on HAART. From the statistical analysis using SPSS program significant with p= 0.004 (OR 15.5 (95% CI (1.73-139.6)) Conclusion: HIV patients on HAART for more than 1 year are known to have increased 15.5 times the risk of poor sleep quality. Keywords: HIV, HAART, sleep quality.