Keywords :
Atypical presentation, Bacterial meningitis, Case report, Complications, Misdiagnosis, Sensitivity and specificity, Tuberculous meningitis
Citation Information :
Diggikar PM, Mundada M, Reddy HR, Pancholi T, Yammanuru BR, Garg L. Atypical Presentation of Tuberculous Meningitis—Challenges in Diagnosis: A Case Report. Indian J Respir Care 2024; 13 (1):69-72.
Tuberculous meningitis (TBM) is associated with severe mortality and morbidity. Current diagnostic modalities lack sensitivity or specificity, and culture inoculation may take up to 4–6 weeks. Atypical presentations of TBM may lead to delays in diagnosis and treatment and cause complications. We present a case of a 17-year-old male who presented with altered sensorium and was initially diagnosed as bacterial meningitis based on the cerebrospinal fluid (CSF) analysis and was treated for the same. The patient did not improve and later developed third cranial nerve (CN) palsy and obstructive hydrocephalus (HC) requiring ventriculoperitoneal (VP) shunting. Reevaluation revealed TBM and the patient was started on antituberculous therapy (ATT). He improved and had no lasting neurological deficits. A high degree of suspicion of tuberculous involvement should be maintained in all patients with meningitis, especially those who do not respond to standard treatment. Finally, we conclude through our case that early diagnosis and treatment can help prevent complications, and newer diagnostic modalities with better sensitivity are required to facilitate early diagnosis and prevent complications.
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