A 68-Year-Old Man with Delirium and Renal Insufficiency

This complex case report describes a 68-year-old man who presented with progressive delirium, renal insufficiency, pancytopenia, and aortitis. Over several months, he developed neurologic decline, cachexia, splenomegaly, and radiographic evidence of soft-tissue thickening around the thoracic and abdominal aorta, interpreted as mycotic aneurysms. Initial diagnosis of sarcoidosis was reconsidered when imaging showed multiple foci of inflammation and FDG uptake; subsequent testing revealed acid-fast bacilli and molecular identification of Mycobacterium bovis. His medical history included bladder cancer treated with intravesical bacille Calmette-Guérin (BCG) therapy years prior. Despite broad antimicrobial treatment and supportive care, the patient deteriorated and died. Autopsy confirmed disseminated M. bovis infection with widespread necrotizing granulomas, including CNS involvement. .

This complex case report describes a 68-year-old man who presented with progressive delirium, renal insufficiency, pancytopenia, and aortitis. Over several months, he developed neurologic decline, cachexia, splenomegaly, and radiographic evidence of soft-tissue thickening around the thoracic and abdominal aorta, interpreted as mycotic aneurysms. Initial diagnosis of sarcoidosis was reconsidered when imaging showed multiple foci of inflammation and FDG uptake; subsequent testing revealed acid-fast bacilli and molecular identification of Mycobacterium bovis. His medical history included bladder cancer treated with intravesical bacille Calmette-Guérin (BCG) therapy years prior. Despite broad antimicrobial treatment and supportive care, the patient deteriorated and died. Autopsy confirmed disseminated M. bovis infection with widespread necrotizing granulomas, including CNS involvement. .