Introduction
Tuberculosis (TB) is one of the most common global health burdens caused
by Mycobacterium Tuberculosis.1 Almost half of the TB
cases remain unreported, contributing to the underdiagnosis of
extrapulmonary tuberculosis.2 The worldwide incidence
of disseminated TB is also in increasing trend. Central nervous system
(CNS) involvement is one of the most devastating complications of
tuberculosis and is seen in 10% of all disseminated TB cases,
accounting for 1% of all TB cases.3 CNS involvement
may present as meningitis, cerebral tuberculoma, tuberculoma abscess,
and thoracic transverse myelopathy.1,4
The predominant symptoms of disseminated TB are fever, cough, malaise,
loss of appetite, weakness, and weight loss. In addition, symptoms
according to system involvement are often seen, like a headache in the
case of meningeal tuberculosis and abdominal pain in peritoneal or
intestinal tuberculosis.5
Although the treatment of disseminated and pulmonary TB are considered
the same, CNS involvement warrants a longer duration of treatment. The
four-drug regimen of rifampicin, isoniazid, pyrazinamide, and ethambutol
is administered daily for two months, followed by rifampicin and
isoniazid for two months. In disseminated cases, these two drug regimens
can be extended. There is no clear evidence of the effectiveness of
corticosteroids in disseminated TB cases. However, steroids are often
used in disseminated cases. 6 Early identification and
prompt management are the cornerstones for optimal patient management in
disseminated TB with CNS involvement.
We reported this case following the updated consensus-based Surgical
Case Report (SCARE) Guidelines. 7