Central nervous system tuberculosis in immunocompetent patients: Two case reports with literature review

Central nervous system tuberculosis (CNS) is a rare but extremely dangerous condition that has been reported in 5%-10% of extrapulmonary tuberculosis cases and accounts for approximately 1% of all tuberculosis cases. We present 2 cases of isolated central system tuberculosis in immunocompetent patients: a 57-year-old female and a 22-year-old young man, both of whom had MRI findings consistent with meningitis and tuberculomas and were complicated by cerebral ischemic infarction in the second case. Despite delaying therapy, both patients who had positive TB tests (PCR and QuantiFERON-TB Gold) nevertheless demonstrated clinical improvement. Although central nervous system tuberculosis has a high mortality rate and a high level of neurological morbidity, diagnosing it remains difficult because clinical symptoms and radiological findings can mimic other conditions such as pyogenic abscess, toxoplasmosis, sarcoidosis, and malignancy.