Tuberculous meningitis manifesting with neuroregression in a eleven month child

Area of Science:

• Neurology
• Pediatrics
• Infectious Diseases

Background:

• Tuberculosis (TB) is a global health concern with varied clinical presentations.
• Neurotuberculosis, particularly TB meningitis, is the most severe form in children, often leading to significant morbidity and mortality if untreated.
• Typical pediatric TB meningitis symptoms include fever, seizures, altered sensorium, and focal neurological deficits.

Observation:

• A case of an eleven-month-old infant presenting with acute regression of developmental milestones over one month as the sole presenting symptom.
• Magnetic Resonance Imaging (MRI) of the brain revealed basal exudates and hydrocephalus, indicative of tuberculous meningitis.
• Cerebrospinal Fluid (CSF) tested via Cartridge-Based Nucleic Acid Amplification Testing (CBNAAT) for TB was negative, but gastric aspirate tested positive for TB. Tuberculin skin testing was positive, and chest X-ray was normal.

Findings:

• The infant had not received the Bacillus Calmette-Guerin (BCG) vaccine, increasing the risk of complicated TB.
• Despite negative CSF results, a combination of clinical presentation, MRI findings, positive gastric aspirate CBNAAT, and positive tuberculin skin test confirmed the diagnosis of tuberculous meningitis.
• Early initiation of Anti-Tubercular Treatment (ATT) led to clinical improvement.

Implications:

• This case highlights the importance of considering tuberculous meningitis in pediatric patients presenting with atypical symptoms like developmental regression.
• Awareness of unusual presentations can lead to earlier diagnosis and prompt treatment, significantly improving prognosis in pediatric neurotuberculosis.
• Diagnostic challenges, such as negative CSF in early stages, necessitate a comprehensive approach including alternative sample testing (e.g., gastric aspirate) and clinical correlation.