A 27-year-old-male was allegedly beaten on the head with a wooden stick, following which he was immediately taken to a local civil hospital. There was no history of loss of consciousness, vomiting, seizure, or bleeding from the ear, nose, or throat. On medicolegal examination, an injury over the forehead's left side was noted, and the patient was discharged after first aid.
Approximately 25 days after the alleged assault, the patient was brought to the outpatient department complaining of fever, productive cough, and shortness of breath for the past 15 days, and weakness on the left side of his body. He did not have any ear pain, discharge, or nose block. He denied any history of recurrent diarrhea or respiratory infections since childhood. He was not a smoker or drug abuser and did not have any past respiratory illness. He had been working at a construction site for 3 months before the illness. On examination, his Glasgow Coma Scale (GCS) score was 15, and the central nervous system examination revealed left hemiparesis. Non-contrast brain computed tomography showed hypodensity in the right frontal and parietal region adjacent to the ventricle. A chest x-ray showed bilateral heterogeneous infiltration of the lungs (Figure 1A). A high-resolution chest computed tomography showed bilateral nodules of varying size and multiple cavities. The abnormalities were evident in both lungs, mainly in the bilateral upper lobes. There was no pleural effusion or significant mediastinal lymphadenopathy (Figure 1B). He was managed with broad-spectrum antibiotics. The diagnostic possibility of tuberculosis was considered, and empirical anti-tuberculosis treatment was started. Five days later, his GCS score deteriorated to 7 and he was admitted to the ward. Cerebral spinal fluid analysis showed 2,100 cells (reference range [RR]: 0-5 cells/mm3) with a predominance of lymphocytes, the glucose of 95 mg/dL (RR: 50-80 mg/dL), proteins of 16 mg/dL (RR: 15-40 mg/dL). Serological investigations for HIV, and hepatitis B and C were negative. A hemogram showed a total leucocyte count of 10,300/mm3 and a differential count was within normal limits; the hemoglobin was 14.4 mg/dL (RR; 13-15 g/dL) and the platelet count was 219,000/muL (RR 150,000-450,000/ muL). His liver function tests and renal function tests were within normal limits. On the third day of hospitalization, he succumbed to the illness. The autopsy was performed owing to the legal implications of this patient's case.