MENINGEAL TUBERCULOSIS: A DIAGNOSTIC CHALLENGE. A CASE REPORT

A 19-year-old malnourished male student from Tabasco, Mexico, with no relevant medical history and a negative HIV test, presented with intermittent holocranial headache that progressively worsened and was accompanied by fever. He subsequently developed a generalized tonic-clonic seizure and progressive neurological deterioration, with positive Brudzinski and Babinski signs. Subarachnoid hemorrhage was initially suspected but was ruled out. Brain magnetic resonance imaging revealed findings suggestive of a central nervous system infectious process, with tuberculous meningitis and neurocysticercosis considered in the differential diagnosis. Despite initial treatment with albendazole and dexamethasone, his neurological condition continued to deteriorate, and cryptococcosis was subsequently considered. Cerebrospinal fluid analysis showed pleocytosis, and molecular testing with Xpert MTB/RIF was performed. The assay was positive for Mycobacterium tuberculosis and detected rifampicin resistance, establishing the diagnosis of tuberculous meningitis. Antituberculosis therapy under a directly observed treatment strategy was initiated on April 16, 2025.