[Cerebral tuberculosis without meningitis in a immunocompetent child]

Area of Science:

• Neurology
• Infectious Diseases
• Pediatrics

Background:

• Cerebral tuberculosis (TB), particularly without meningitis, presents diagnostic challenges.
• High morbidity and mortality rates underscore the urgency of timely diagnosis and treatment.

Observation:

• A previously healthy 11-month-old infant presented with prolonged fever, developmental regression, and signs of increased intracranial pressure.
• Imaging revealed hydrocephalus and multiple intra- and extra-axial lesions.
• Cerebrospinal fluid analysis, including molecular tests for TB, was negative.

Findings:

• Cerebellar biopsy confirmed chronic necrotizing granulomatous inflammation with acid-alcohol resistant bacilli, establishing the diagnosis of cerebral TB.
• The case highlights a rare presentation of TB without meningeal involvement.

Implications:

• Emphasizes the critical importance of considering cerebral TB in pediatric cases with unexplained neurological symptoms, even with negative initial CSF studies.
• Recommends exhaustive etiological investigation, including invasive procedures like biopsy, for definitive diagnosis and appropriate management of pediatric cerebral TB.