Psychosis secondary to tuberculosis meningitis

Area of Science:

• Neurology
• Infectious Diseases
• Psychiatry

Background:

• Psychotic disorders can manifest with varied etiologies.
• Tuberculosis meningitis (TBM) is a severe form of extrapulmonary tuberculosis affecting the central nervous system.
• Early diagnosis and treatment of TBM are crucial for favorable outcomes.

Observation:

• A 19-year-old immunocompetent woman presented with a year-long worsening psychotic disorder, including social isolation, mutism, and stupor.
• Clinical examination revealed a stuporous state with akinesia, upper motor neuron signs, and neck stiffness.
• Brain imaging and EEG were normal, but cerebrospinal fluid analysis showed positive Mycobacterium tuberculosis PCR (MTB PCR).

Findings:

• Cerebrospinal fluid analysis confirmed Mycobacterium tuberculosis infection as the cause of the neurological and psychiatric symptoms.
• Empirical treatment with antituberculosis drugs and steroids was initiated.
• The patient experienced a complete resolution of psychotic symptoms within one month of treatment.

Implications:

• This case highlights that tuberculous meningitis should be considered in the differential diagnosis of unexplained psychotic disorders, even in immunocompetent individuals.
• Early detection of Mycobacterium tuberculosis in CSF is vital for timely intervention.
• Successful treatment with antituberculosis therapy and steroids can lead to full neurological and psychiatric recovery.