RESUMEN
Description The Care Alert program is designed to help navigate encounters with patient populations that are high utilizers of emergency department (ED) resources. These populations often have chronic medical conditions, have a poor understanding of their conditions, are unfamiliar with the EDs' role in the management of these conditions, and commonly lack outpatient resources. The Care Alert program intends to address the needs of this challenging patient population by designing individualized care plans that are approved through a multidisciplinary committee. Data from this study showed a 37% decrease in ED visits and a 47% decrease in hospitalizations during the initial 8 months of implementation.
RESUMEN
Central nervous system (CNS) involvement occurs in about 1% of all tuberculosis (TB) cases, classically presenting as a meningitis. Intracerebral tuberculomas are a much rarer manifestation. We describe the case of a young black male who presented with new-onset seizure. Cerebral computerized tomography from an outside hospital reportedly showed findings concerning for septic emboli. Brain magnetic resonance imaging at our institution confirmed the presence of multiple, peripherally enhancing lesions in the right frontal and temporal lobes, cerebellum, and pons. Thoracentesis was performed for a concomitant pleural effusion, which contained elevated levels of adenosine deaminase and ultimately grew Mycobacterium tuberculosis. After ruling out other causes, we reached a diagnosis of CNS TB manifesting as cerebral tuberculomas. The patient was initiated on a course of rifampin, isoniazid, pyrazinamide, and ethambutol for two months, followed by rifampin and isoniazid to complete at least twelve months of antimicrobial therapy. We present this case to highlight this unusual manifestation of CNS TB and review the challenges in diagnosis.
