A Middle Aged Patient Living with HIV (PLHIV), Presented with Persistent Hiccups, Imbalance, and Multifocal Myoclonus Secondary to Disseminated Tuberculosis

A middle-aged male presented with subacute onset, progressive illness with diarrhea, persistent hiccups, bilateral hand tremors, gait imbalance, multifocal myoclonus, and weight loss. Clinically, the patient also had cachexia, pallor, oral thrush, and hepatosplenomegaly.. Investigation indicated chronic HIV infection, anemia of chronic disease, transaminitis, hyponatremia, CSF pleocytosis (lymphocyte predominant), elevated CSF protein, diffuse pachymeningeal enhancement on the brain MRI, mediastinal and abdominal necrotic lymphadenopathy, circumferential bowel wall thickening, and hepatosplenomegaly on CECT abdomen. CECT chest exhibited centrilobular nodular opacities. His sputum gene Xpert ® MTB/RIF was positive for Mycobacterium tuberculosis. He had disseminated tuberculosis with tubercular meningitis, which caused persistent hiccups, gait abnormalities, and multifocal myoclonus. His symptoms resolved with antitubercular treatment. Myoclonus is a rare occurrence with tubercular meningitis.