Stage III tuberculous meningoencephalitis with brain abscess in a young infant: a rare case report

Abstract

Tuberculous meningitis (TBM) is the most severe form of TB in children and is associated with high mortality and related morbidities. Some of the rare complications of TBM, especially in infants, are formation of brain abscess, hydrocephalus, vasculitis, and cerebral infarction. We reported a case of a 3 ½ months old female infant who presented with fever, cough, irritability, poor feeding, and continuous convulsions. Investigations revealed basal meningeal exudates, multiple cerebral and brainstem infarcts, vasculitis, tuberculomas, hydrocephalus, and a left parietal brain abscess. CSF findings were suggestive of TBM. The patient was diagnosed with stage III tuberculous meningoencephalitis complicated by multiple deep cortical and brainstem infarcts, vasculitis, tuberculomas, hydrocephalus, brain abscess and status epilepticus. She was managed successfully with anti-tubercular therapy, corticosteroids, antiepileptics, abscess evacuation, Ommaya reservoir insertion, and ventriculoperitoneal (VP) shunting. Significant improvement has been noted, and she is in stable condition.