Tuberculous meningitis as an underlying cause of rapid neurological deterioration in a patient with a history of psychiatric disorder: Clinical case report

Abstract

Tuberculous meningitis (TBM), the least common of extrapulmonary tuberculosis presentations, one of the most severe. Highly prevalent in immunosuppressed individuals it is associated with high mortality and significant neurological sequelae. TBM main complications are hydrocephalus, increased intracranial pressure, and compromised blood flow with poor prognosis. The diagnostic approach is complex, as the manifestations of TBM are nonspecific. In the case reported here, the first symptoms of TBM were masked by clinical manifestations of depressive syndrome (previously diagnosed) and its management with antidepressants. The confirmatory diagnosis was based on GenXpert on cerebrospinal fluid and neuroimaging, as in our case, tools frequently delayed. The patient presented sudden neurological deterioration, probably due to dysregulation of the immune system associated with depression and smoking habits. In areas with a high incidence of TB, neurological manifestations, even in patients with psychiatric disorders, should be considered as a differential diagnosis or infectious comorbidity such as TBM.