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3 Our patient's clinical picture of widespread neurological symptoms disseminated in time and space pointed initially towards multiple sclerosis. This was later ruled out by the MRI results. Central nervous system TB presenting with progressive weakness within different anatomical distribution and in different timing has not been reported in literature in the past. We came across cases of isolated brainstem or isolated cerebral TB. This is the first report of a synchronous brainstem tuberculoma with two right cerebral lesions. The normal CSF examination and the absence of menigism or resent history of headaches suggest that the mode of infection was the haematogenous spread. Learning points Brainstem tuberculoma is rare in the developed world. Diagnosis is based on the imaging features on the MRI. Antituberculosis treatment should be started before waiting to isolate the bacteria due to the risk of permanent neurological damage if treatment is delayed. Footnotes Competing interests: None. Patient consent: Obtained. Provenance and peer review: Not commissioned; externally peer reviewed.""Systemic lupus erythematosus (SLE) is a multisystemic disease which can affect virtually any bodily organ. Pericarditis and pericardial effusion are well-recognised cardiac complications of SLE, with pericardial effusions seen in up to 50% of patients with SLE.1 However, cardiac tamponade has been rarely described especially as an initial presenting feature of SLE. In this case, a patient with undiagnosed SLE Tryptophan synthase presents with features of nephrotic syndrome and global pericardial effusion which has resulted in cardiac tamponade. It is imperative that cardiac tamponade is diagnosed promptly through thorough physical examinations and appropriate investigations as early pericardiocentesis can be lifesaving. Injudicious use of diuretics for fluid retention should be avoided as they could reduce cardiac filling and worsen cardiac tamponade. Case presentation A 45-year-old Nigerian woman presented to a district general hospital with 4-week history of worsening bilateral leg oedema, abdominal distension and oliguria. Over the 3?weeks prior to admission, she also noticed a non-productive cough and orthopnoea for which she was started on furosemide in community by her GP. Since then, she had developed worsening dyspnoea with sharp, intermittent left-sided chest pain which warranted her admission to hospital. The pain was worse on exertion and coughing, and resolved spontaneously. Each episode lasted from 15?min to 5?h. She also complained of pruritus and described three episodes of rectal bleeding with streaks of fresh red blood over the 3?days prior to admission. She admitted a travel history to Africa last year. She has a history of hypertension for which she takes lisinopril (10?mg twice daily). She was diagnosed with diabetes 1?year ago which had been diet-controlled.