Hydrocephalus Caused by Tuberculous Meningitis in an Immunocompetent Young Adult: A Case Report

Abstract

Background

Despite improved medical management, meningeal tuberculosis mortality and other outcomes have changed slightly over time due to a delay in diagnosis and treatment. This study reports a rare case of tuberculous meningitis in an immunocompetent host, calling into question the commonly held belief that tuberculous meningitis is a disease of immunocompromised individuals.

Case Presentation

A 26-year-old male with no significant past medical history, tuberculosis, or indications of immunological compromise, was admitted to our hospital with a fever and altered mental status. He was drowsy, febrile (temperature of 38°C), had a heart rate of 110 beats per minute, and showed mild neck stiffness but no meningeal sign. A lumbar puncture on the third day of admission suggested tuberculous meningitis. He was treated for tuberculosis meningitis, and his condition slightly improved. However, the patient’s condition suddenly worsened, and a repeat contrast computed tomography (CT) of the brain showed the development of ventriculomegaly and basilar enhancement. Insertion of an emergency ventriculoperitoneal shunt was performed; however, the patient died ten days after hospital admission.

Conclusion

We report a fatal case of tuberculous meningitis in an immunocompetent patient. Healthcare practitioners must be trained to identify and diagnose tuberculous meningitis promptly. Early treatment of tuberculous meningitis based on clinical diagnosis and symptoms improves clinical outcomes.

Keywords:

• immunocompetent
• meningitis
• tuberculosis

Data Sharing Statement

Data and materials are available upon request to the first author, Rizaldy Taslim Pinzon ([email protected]).

Ethical Approval

Due to the nature of this case report, this study does not require ethical committee approval. The Bethesda Hospital Research and Development Department has granted permission for this investigation. In compliance with the Helsinki Declaration, the patient’s identity was concealed.

Consent for Publication

The authors obtained the patient’s written approval before publishing this case report.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors disclose that they have no competing interests.

Additional information

Funding

The authors funded this case report.