An unusual triad: tuberculomas, tubercular meningitis, and hydrosyringomyelia in a child from a suburban region

TL;DR

A child with CNS tuberculosis showed rare symptoms including brain tuberculomas, meningitis, and spinal issues, successfully treated with surgery and drugs.

Contribution

This case highlights the rare co-occurrence of tuberculomas, meningitis, and hydrosyringomyelia in pediatric CNS tuberculosis.

Findings

MRI identified multiple brain tuberculomas, meningeal enhancement, and spinal hydrosyringomyelia.

Surgical removal and antitubercular therapy led to a positive clinical response.

Early neuroimaging is crucial for diagnosing CNS tuberculosis in children from endemic areas.

Abstract

Central nervous system (CNS) tuberculosis is a rare but serious manifestation of Mycobacterium tuberculosis infection, especially in the paediatric population.

We report a rare case of an eight year old male child from a suburban region presenting with intracranial tuberculomas, tubercular meningitis, and spinal hydrosyringomyelia (HSM). Magnetic Resonance Imaging (MRI) revealed multiple brain tuberculomas, basal exudates, abnormal meningeal enhancement, spinal HSM with features of arachnoiditis. The patient was operated for removal of tuberculomas and placement of ventriculo-peritoneal (V-P) shunt and responded well to antitubercular therapy and corticosteroids.

Tuberculosis should be considered in the differential diagnosis in children presenting with unexplained neurological symptoms in endemic regions. Early neuroimaging is critical in avoiding morbidity and permanent neurological damage.

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