A case report of tuberculous meningitis resulting in irreversible visual impairment due to delayed diagnosis

Prompt diagnosis of tuberculous meningitis (TBM) is crucial to prevent severe complications like cranial nerve involvement and irreversible visual impairment. Early suspicion and intervention are essential, especially in tuberculosis-endemic regions. Rapid initiation of anti-tuberculosis therapy and vigilant monitoring for complications, such as hydrocephalus, improve patient outcomes and prevent long-term disabilities.

This case study provides a comprehensive overview of the difficulties associated with predicting and managing tuberculous meningitis (TBM). The predictive aspect is hindered by the subacute nature of TBM, featuring a prodromal phase lasting 7-10 days, followed by manifestations like severe headaches, altered mental status, stroke, hydrocephalus, and cranial neuropathies. Additionally, vision loss is a disabling complication. All components of the visual pathway, especially the optic nerve and optic chiasma, are frequently and dominantly affected. While antibiotics can promptly resolve meningitis in most cases, approximately 10% of infections progress to chronic meningitis, with tuberculosis meningitis being the most common form. Our patient initially presented with nonspecific symptoms, which later evolved into symptoms that indicate viral meningitis and was started on empirical therapy. Subsequently, due to clinical suspicion of tuberculosis meningitis and persistent symptoms despite treatment, she was placed in anti-tuberculosis therapy (ATT) but unfortunately developed complications such as hydrocephalus and blindness. To address the hydrocephalus, a Ventriculo-Peritoneal shunt was implanted. Despite delayed treatment and diagnosis, most of her symptoms resolved except for blindness, for which there was only partial recovery.