Co-occurrence of Tuberculous Meningitis and Intestinal Perforation in Abdominal Tuberculosis (TB): A Report of a Rare Case From Pakistan

TL;DR

A rare case of a 15-year-old girl with both tuberculous meningitis and intestinal TB perforation is reported, emphasizing the need for early diagnosis and interdisciplinary care.

Contribution

This paper presents a rare clinical case of co-occurring tuberculous meningitis and intestinal TB perforation in a single patient.

Findings

The patient's cerebrospinal fluid analysis confirmed tuberculous meningitis with lymphocytic pleocytosis and acid-fast bacilli.

Surgical exploration revealed multiple ileal perforations confirmed to be caused by TB via histopathology.

The case underscores the diagnostic and therapeutic challenges of managing concurrent TB in the central nervous system and gastrointestinal tract.

Abstract

Tuberculosis (TB) remains a significant global health concern, with millions affected worldwide each year. Extrapulmonary TB, particularly involving the digestive tract and central nervous system, poses distinctive difficulties in both diagnosis and treatment. We report a case involving a 15-year-old girl with a history of intestinal TB on anti-tuberculous therapy who presented with symptoms suggestive of meningitis, along with abdominal pain and distension. Our initial suspicion was tuberculous meningitis, considering the underlining abdominal TB, which was later supported by cerebrospinal fluid analysis showing lymphocytic-predominant pleocytosis and positive acid-fast bacilli staining. Concurrently, the patient developed hemodynamic instability and severe abdominal pain, which on repeat X-rays of the abdomen showed air under the diaphragms, prompting surgical exploration and revealing multiple ileal perforations. Histopathological examination confirmed TB as the cause of perforation. This case highlights the diagnostic and therapeutic complexities of concurrent tuberculous meningitis and intestinal TB perforation. Early recognition and interdisciplinary management are crucial for optimal patient outcomes.

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