Tuberculous peritonitis complicated by immunologic cerebral vasculitis

Area of Science:

• Neurology
• Immunology
• Infectious Diseases

Background:

• Tuberculosis (TB) is a global infectious disease with diverse extrapulmonary manifestations.
• Cerebral infarctions are typically associated with vascular risk factors or direct infection, but immune-mediated mechanisms are less understood.

Observation:

• A 53-year-old female presented with ascites, decreased responsiveness, and right-sided limb weakness.
• Peritoneal biopsy revealed necrotizing granulomatous inflammation with positive TB nucleic acid amplification testing.
• Brain MRI demonstrated multiple acute infarcts in the cerebral hemispheres and cerebellum.

Findings:

• Cerebral infarction in this patient was not attributed to secondary causes, tuberculous meningitis, or direct injury.
• The likely cause of multiple cerebral infarctions was identified as immunologic injury secondary to tuberculosis.
• This represents a rare instance of TB-induced immune injury leading to cerebral infarction, with only one prior report.

Implications:

• This case underscores the potential for tuberculosis to trigger immune-mediated neurological complications, specifically cerebral infarction.
• Further research into the immunopathogenesis of TB-related neurological injury is warranted.
• Clinicians should consider immune-mediated mechanisms when encountering neurological deficits in patients with active tuberculosis.