Central Nervous System Tuberculosis With Shower Like Pattern of Intracranial Tuberculomas in an Immunocompetent Patient

Abstract

Central nervous system tuberculosis (CNS TB), though comparatively uncommon as compared to other forms of extrapulmonary tuberculosis (TB), results in high morbidity and mortality. The symptoms are non-specific and of a progressive nature resulting in delayed diagnosis. We present a case of CNS TB that presented two months after the onset of symptoms. The patient’s condition reached the point of being bedbound. On investigation, the widespread involvement of the brain with shower-like pattern of ring enhancing tuberculomas and associated tuberculous meningitis was found. This was a surprising finding considering the patient was immunocompetent. Contrast-enhanced magnetic resonance imaging showed lesions in midbrain, pons, medulla, thalamus, bilateral cerebellar hemispheres and bilateral cerebral hemispheres. Upon treatment initiation the patient responded well with resolution of all lesions.

Clinical Management of Pathogen-Negative Tuberculous Meningitis in Adults: A Series Case Study

“…We reviewed 16 cases of pathogenic negative tuberculous meningitis since 2020 [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ] (see Supplementary Table S4 ). These case reports are similar to our cases, mainly because of their atypical clinical manifestations or lesion sites, such as one-and-a-half syndrome [ 35 ], nonconvulsive status epilepticus [ 36 ], oculomotor palsy [ 38 ], lesions involving clivus [ 31 ], and midbrain [ 32 ].…”