Paucibacillary tuberculous meningitis with clinical-radiological dissociation: A diagnostic challenge.
Tianjiao Tang, Junguo Cao, Mantao Chen et al.
✦ AI-curated · Sources linked
Case in brief
A 63-year-old woman with newly diagnosed diabetes presented with stroke-like symptoms, including hemiparesis and aphasia, but lacked typical signs of infection. Initial neuroimaging and cerebrospinal fluid analysis suggested viral encephalitis, and symptoms resolved after empirical treatment. However, follow-up MRI showed paradoxical lesion progression, and a meningeal biopsy ultimately revealed granulomatous inflammation consistent with tuberculous meningitis.
What made this case unusual
The case highlights a clinical-radiological dissociation where tuberculous meningitis presented without typical infectious symptoms, complicating the diagnosis.
Diagnostic / clinical pearl
Clinicians should maintain a high index of suspicion for tuberculous meningitis in patients presenting with neurological symptoms, even in the absence of classic infectious signs.
Why it matters
This case emphasizes the importance of considering tissue biopsy in atypical presentations of central nervous system infections to avoid misdiagnosis.