In developed countries, meningeal tuberculosis, with its non-specific clinical presentation, has a low incidence, and early diagnosis is challenging. Based on the clinical suspicion, which must be rapid, the work-up includes cerebrospinal fluid analysis showing hypoglycorrhachia and lymphocytosis features, and should be complemented by imaging studies (preferably magnetic resonance). The diagnostic gold standard remains direct microscopic examination, which requires specifically trained personnel, supplemented by mycobacterial culture, which implies long processing time. Nucleic acid amplification techniques (PCR), which are fast and specific, are not widely available in general practice settings and have poor sensitivity in non-respiratory samples. Skin test and IGRA test may be negative in cases of active and/or severe tuberculosis. To highlight the current challenges in managing extrapulmonary tuberculosis, we report a case of severe meningeal tuberculosis and delayed and difficult diagnosis despite the availability of modern molecular biology diagnostic tools.
What is already known about the topic?
Meningeal tuberculosis is a rare and challenging diagnosis. It is a therapeutic emergency with high morbidity and mortality.
What does this article bring up for us?
Based on a clinical case, we provide an overview of current knowledge regarding diagnosis and treatment.
Keywords
Meningeal tuberculosis, cerebrospinal fluid, extrapulmonary tuberculosis, mycobacteria