RESUMO Introdução: O objetivo deste trabalho foi relatar um caso de tuberculose com manifestações neurológicas pouco frequentes, em paciente em situação social vulnerável, usuário de drogas, com má adesão ao tratamento. Desenvolvimento: Paciente do sexo masculino, 32 anos, de etnia indígena, previamente hígido, usuário de drogas, que abriu quadro de perda ponderal, sudorese noturna e fraqueza em membros inferiores sem sintomas pulmonares, evoluindo no período de 3 meses com paraplegia, retenção urinária e fecal. Durante investigação foi evidenciado um quadro de tuberculose disseminada na apresentação de tuberculose pulmonar associada às formas extrapulmonares de tuberculose (tuberculomas intracerebral, intracerebelar e intramedular). Iniciado esquema específico para tuberculose apresentando melhora importante da paraplegia e recuperação total das funções esfincterianas. Teve alta para manter seguimento na Atenção Primária por 1 ano, porém abandonou tratamento após 7 meses e há relato de uso diário e abusivo de drogas. Considerações finais: Este caso enfatiza como a vulnerabilidade social gera uma susceptibilidade clínica, enfrentada pelas pessoas acometidas pela tuberculose e consumo de drogas ilícitas. Palavras-chave: Tuberculose; tuberculoma intramedular; tuberculoma intracraniano; Usuários de Drogas; Vulnerabilidade Social ABSTRACT Introduction: The objective of this study was to report a case of tuberculosis with infrequent neurological manifestations, in a patient in a vulnerable social situation, drug user, with poor adherence to treatment. Development: A 32-year-old male patient of indigenous ethnicity, previously healthy, drug user, who developed weight loss, night sweats and weakness in the lower limbs without pulmonary symptoms, evolving within 3 months with paraplegia, urinary and fecal retention. During investigation, a picture of disseminated tuberculosis was evidenced in the presentation of pulmonary tuberculosis associated with extrapulmonary forms of tuberculosis (intracerebral, intracerebellar and intramedullary tuberculomas). A specific regimen for TB was started, and progressed with significant improvement in paraplegia and full recovery of sphincter functions. He was discharged to maintain treatment in Primary Care for 1 year, but abandoned treatment after 7 months and reported daily and abusive drug use. Final Considerations: This case emphasizes how social vulnerability generates a clinical vulnerability faced by people affected by tuberculosis and the consumption of illicit drugs. Keywords: Tuberculosis; intramedullary tuberculoma; intracranial tuberculoma; Drug users; Social vulnerability
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