A case of tubercular meningoencephalitis with transverse myelitis

Abstract

Central nervous system tuberculosis accounts for approximately 1% of all tuberculosis cases. Transverse myelitis is an extremely rare manifestation of central nervous system tuberculosis, involving 1 or more vertebral segments of the spinal cord. However, it may extend to involve 3 or more segments of the cord, which would then be designated as longitudinally extensive transverse myelitis. Tubercular transverse myelitis may occur in isolation or in association with adjacent meningitis. We present a case of 39-year-old male, who presented with fever, headache, and bilateral lower limb weakness and was eventually diagnosed with tubercular meningoencephalitis with transverse myelitis. The diagnosis was made based on imaging findings correlated with cerebrospinal fluid analysis and microbiological reports. The patient showed significant clinical and radiological improvement following the antitubercular therapy. This case highlights that tuberculosis should always be considered in our differential diagnosis for any pathology with extensive involvement of the meninges, brain and spinal cord, especially in regions with a high prevalence.

Keywords

• Tuberculosis
• Spinal tuberculosis
• Longitudinally extensive transverse myelitis
• Enhancing basal exudates