Disseminated tuberculosis with central nervous system involvement in an adolescent: the consequences of missed preventive therapy and absent immunization

Abstract

Adolescents are particularly susceptible to tuberculosis, especially severe manifestations such as disseminated tuberculosis with central nervous system involvement. This case study illustrates the repercussions of neglected preventive measures, specifically the lack of immunization and tuberculosis preventive therapy, in an adolescent with confirmed household tuberculosis exposure. An 11-year-old female presented with decreased consciousness, prolonged fever, chronic cough, and significant weight loss. She had not received childhood immunizations and resided in a densely populated household with known tuberculosis exposure. Upon admission, she exhibited moderate illness with signs of meningeal irritation, moderate malnutrition, and a Glasgow Coma Scale score of E2V2M4. Neuroimaging revealed multiple intracranial tuberculomas, basal meningeal enhancement, brain edema, and communicating hydrocephalus. A chest X-ray indicated bilateral infiltrates. GeneXpert MTB/RIF testing of cerebrospinal fluid and gastric aspirate confirmed rifampicin-sensitive Mycobacterium tuberculosis. This case underscores the severe outcomes of disseminated tuberculosis with central nervous system involvement in the absence of preventive strategies. Both isoniazid preventive therapy, which has been shown to reduce tuberculosis risk by 60–90 %, and Bacillus Calmette-Guérin vaccination, which provides 70–80 % protection against severe tuberculosis, were missed opportunities that could have altered disease progression. Preventive interventions such as immunization and tuberculosis preventive therapy must be prioritized in high-risk pediatric populations, particularly among tuberculosis contacts. Early implementation may significantly reduce tuberculosis-related morbidity and mortality, especially in resource-limited settings.

Keywords

• disseminated tuberculosis
• central nervous system
• adolescent
• immunization tuberculosis prevention