Multi Drug Resistant Tuberculous Meningoencephalitis in a Young Adult

Abstract

Introduction Tuberculous meningoencephalitis (TBM) is a rare form of tuberculosis. Despite advances in diagnostics and treatment, TBM has a high mortality rate and requires timely intervention to reduce long term neurological complications [1,2]. This clinical case highlights the challenges of diagnosing and treating TBM, particularly in the context of drug resistance . Case Presentation An 18 year old male presented with fever, nausea, vomiting, dizziness and headache. Initial workup including cerebrospinal fluid (CSF) analysis and brain CT, was inconclusive. Since the cause of meningoencephalitis could not be determined, empirical treatment with acyclovir, ceftriaxone, and vancomycin was initiated. This treatment had no positive effect and the patient's neurological condition continued to deteriorate. Considering the family history, CSF analysis, clinical progression, and radiological imaging, treatment for tuberculous meningoencephalitis was initiated following the HRZE regimen with addition of dexamethasone. However, the patient's condition continued to deteriorate, eventually reaching a Glasgow Coma Scale score of 5. Therefore, despite negative results from GeneXpert MTB/RIF and AFB microscopy, the diagnosis of multi drug resistant tuberculosis was made based on family history. Subsequently, treatment following a a bedaquiline-levofloxacin-linezolid-clofazimine-terizidone (BdqLfx-Lzd-Cfz-Tzd) regimen was initiated. Following this treatment the patient improved significantly and soon regained consciousness. The clinical course was complicated by hydrocephalus requiring formation of an intraventricular drain and later a ventriculoperitoneal shunt was formed. The case was also complicated by bacterial and fungal sepsis. After 18 months of treatment, the patient was discharged in a stable condition with minimal residual effects. Discussion This case highlights the diagnostic challenges of TBM, when initial tests may be inconclusive. Advanced diagnostic tools like GeneXpert MTB/RIF are crucial for early detection, but drug-resistant tuberculosis can complicate diagnosis and treatment [2,3]. Conclusions Consider TBM in patients with meningitis, especially when initial treatments fail. Rapid diagnostics and aggressive treatment are vital for better prognosis.