Severe tuberculous meningoencephalitis in a 30-year old woman with active systemic lupus erythematosus

Tuberculosis is a significant cause of morbidity and mortality in immunocompromising diseases such as systemic lupus erythematosus (SLE). It often is difficult to distinguish between central nervous system (CNS) involvement and infectious complications in SLE. We report the case of a 30-year-old woman with active SLE and severe tuberculous meningoencephalitis. The diagnosis of tuberculous meningoencephalitis was confirmed by cerebrospinal fluid culture examination, which revealed mycobacterium tuberculosis and typical findings for tuberculous meningoencephalitis on magnetic resonance imaging. Despite treatment with isoniazid, rifampicin, ethambutol, streptomycin, and prednisone, the patient developed significant neurological deficits. This case is a reminder that febrile episodes in patients with SLE should always lead to aggressive evaluation for infection. The early clinical symptoms of tuberculous meningitis often are nonspecific. Because of the unfavorable prognosis in latetreated and untreated cases, even a suspicion should lead to a trial of antituberculous treatment.