Misra Garima, Kosaraju Sree Nithya, Bhatti Bhawarpreet Singh
Neurology, ESIC Medical College and Hospital, Hyderabad, IND.
Neurology, Raja Rajeshwari Institute of Medical Sciences, Hyderabad, IND.
Cureus. 2025 Aug 4;17(8):e89312. doi: 10.7759/cureus.89312. eCollection 2025 Aug.
Tubercular (TB) meningitis is one of the manifestations of central nervous system tuberculosis, a form of extrapulmonary tuberculosis. Despite the high incidence of TB meningitis in developing countries, there are hardly any reports of associated ventriculitis, making it one of the rare complications. Ventriculitis complicating TB meningitis is devastating not only to the immunocompromised but also to the immunocompetent population. The diagnosis of TB meningitis is indeed challenging, owing to the clinical similarities with other types of meningitis and laboratory techniques that are rather insensitive and slow. Thus, this under-recognized complication can impact the morbidity and mortality of the people affected by it, making it imperative for it to be diagnosed and managed early. We present a case of a 52-year-old man with no known comorbidities, who presented with fever, chills, headache, vomiting, and altered mental status for four days, and showed a Glasgow Coma Scale (GCS) score of 8 (E2V2M4), stiffness of the neck, sluggishly reactive pupils, and tachycardia on arrival. The pathological findings, including CSF analysis, MRI, and cartridge-based nucleic acid amplification test (CBNAAT), diagnosed the case as TB ventriculitis with meningitis. The patient was mechanically ventilated and then treated with anti-TB treatment and steroids. The case thus illustrates a rare and challenging presentation of TB meningitis that can present with a variety of neurological sequelae and complications, including ventriculitis, as in this case, which can have devastating consequences if left untreated. It can result in persistent neurological sequelae, hydrocephalus, and prolonged hospital stay. Hence, our case highlights the need for a timely diagnosis and treatment that can help improve the prognosis, thereby reducing morbidity and mortality.
结核性脑膜炎是中枢神经系统结核病的一种表现形式，属于肺外结核病。尽管在发展中国家结核性脑膜炎发病率很高，但几乎没有关于其合并脑室炎的报道，使其成为罕见的并发症之一。结核性脑膜炎合并脑室炎不仅对免疫功能低下者，而且对免疫功能正常者都具有毁灭性。结核性脑膜炎的诊断确实具有挑战性，这是因为其临床表现与其他类型脑膜炎相似，且实验室检测技术相当不敏感且耗时。因此，这种未得到充分认识的并发症会影响患者的发病率和死亡率，所以必须尽早诊断和处理。我们报告一例52岁男性病例，该患者无已知合并症，因发热、寒战、头痛、呕吐及意识状态改变4天就诊，入院时格拉斯哥昏迷量表（GCS）评分为8分（E2V2M4），伴有颈部强直、瞳孔反应迟钝及心动过速。病理检查结果，包括脑脊液分析、磁共振成像（MRI）和基于 cartridge 的核酸扩增检测（CBNAAT），确诊该病例为结核性脑室炎合并脑膜炎。患者接受机械通气，随后接受抗结核治疗和类固醇治疗。该病例说明了结核性脑膜炎一种罕见且具有挑战性的表现形式，它可伴有多种神经后遗症和并发症，如本例中的脑室炎，如果不治疗可能会产生毁灭性后果。它可导致持续性神经后遗症、脑积水及住院时间延长。因此，我们的病例强调了及时诊断和治疗的必要性，这有助于改善预后，从而降低发病率和死亡率。
