Intraspinal and intracranial Neurotuberculosis: A case report

Tuberculosis meningitis (TBM) is the most devastating form of tuberculosis (TB), causing high mortality or disability. The diagnosis of tuberculous meningitis is notably difficult due to its rapid onset and nonspecific symptoms. Early recognition and targeted treatment are the principal means of ensuring tuberculosis control. Here we report a case of tuberculosis meningitis with nonspecific symptoms including mental and cognitive impairments concomitant to Iliopsoas muscle abscess and spondylodiscitis.

Here we describe a case of TBM in a 38- year- old Asian male. He presented with behavioral change, back pain, progressive walking impairment and headache. Thoracic and lumbosacral MRI demonstrated Gibbus deformity with thoracic spondylodiscitis and bilateral Iliopsoas muscle abscess. Brain MRI finding included basal leptomeningeal enhancement. He was started on antituberculous therapy. During hospitalization, the patient's level of consciousness decreased, and he was admitted to the intensive care unit. Surgery for correct kyphotic deformity was done, and the patient discharged about two months after admission.

Tuberculosis should be considered as a possible important etiology of acute bacterial meningitis that may commonly present as an afebrile illness in patients with gradually progressive mental and cognitive impairments or psychotic bizarre behaviors which leads to failure of early diagnosis.