Indian Journal of Respiratory Care

IJRC Email      Register      Login

VOLUME 13 , ISSUE 1 ( January-March, 2024 ) > List of Articles


Atypical Presentation of Tuberculous Meningitis—Challenges in Diagnosis: A Case Report

Pradnya Mukund Diggikar, Mayank Mundada, Hansini Raju Reddy, Tushar Pancholi, Bhavyasri Reddy Yammanuru, Loveleen Garg

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.

DOI: 10.5005/jp-journals-11010-1090

License: CC BY-NC 4.0

Published Online: 06-04-2024

Copyright Statement:  Copyright © 2024; The Author(s).


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.

PDF Share
  1. Tuberculosis | Harrison's Principles of Internal Medicine, 21e | AccessMedicine | McGraw Hill Medical [Internet]. [cited 2023 Oct 12]. Available from:§ionid=265423319
  2. Wang MG, Luo L, Zhang Y, et al. Treatment outcomes of tuberculous meningitis in adults: a systematic review and meta-analysis. BMC Pulm Med 2019;19(1):200. DOI: 10.1186/s12890-019-0966-8
  3. Marais S, Thwaites G, Schoeman JF, et al. Tuberculous meningitis: a uniform case definition for use in clinical research. Lancet Infect Dis 2010;10(11):803–812. DOI: 10.1016/S1473-3099(10)70138-9
  4. Manyelo CM, Solomons RS, Walzl G, et al. Tuberculous meningitis: pathogenesis, immune responses, diagnostic challenges, and the potential of biomarker-based approaches. J Clin Microbiol 2021;59(3):e01771–e01820. DOI: 10.1128/JCM.01771-2
  5. Ho J, Marais BJ, Gilbert GL, et al. Diagnosing tuberculous meningitis - have we made any progress? Trop Med Int Health 2013;18(6):783–793. DOI: 10.1111/tmi.12099
  6. Thwaites GE, van Toorn R, Schoeman J. Tuberculous meningitis: more questions, still too few answers. Lancet Neurol 2013;12(10):999–1010. DOI: 10.1016/S1474-4422(13)70168-6
  7. Kurihara M, Kuroki T, Nomura Y, et al. The challenge of differentiating tuberculous meningitis from bacterial meningitis. Respirol Case Rep 2022;10(3):e0910. DOI: 10.1002/rcr2.910
  8. Rasheed W, Qureshi R, Jabeen N, et al. Diagnostic accuracy of high-resolution computed tomography of chest in diagnosing sputum smear positive and sputum smear negative pulmonary tuberculosis. Cureus 2020;12(6):e8467. DOI: 10.7759/cureus.8467
  9. Thwaites GE, Nguyen DB, Dung NH, et al. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. N Engl J Med 2004;351(17):1741–1751. DOI: 10.1056/NEJMoa040573
  10. Davis A, Meintjes G, Wilkinson RJ. Treatment of tuberculous meningitis and its complications in adults. Curr Treat Options Neurol 2018;20(3):5. DOI: 10.1007/s11940-018-0490-9
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.