Tuberculosis Meningitis: A Case Report

Background: Currently, Portugal presents low risk of Mycobacterium tuberculosis infection. In 2014, the incidence of the disease reached the limit of low incidence (20/100,000 inhabitants) that remains until the present time. In 2016, BCG vaccination strategy was changed from a universal strategy to selective (risk groups).
Objective: Case report of a 17-year-old adolescent with iron deficiency anaemia, who had been medicated for 3 months with oral iron, that went to urgency due to night-time holocranial headache that interfered with sleep associated with photophobia, phonophobia and night fever. He presented with anorexia, asthenia and weight loss of 8 Kg with 1 month of evolution. At admission, a decrease in the vesicular murmur in the right pulmonary base was identified. He did not present alterations in the neurological examination, namely meningeal signs. The blood count did not reveal changes and the inflammatory parameters were negative. A chest X-ray revealed small pleural effusion on the right. CT of the chest and molecular research of Mycobacterium tuberculosis in respiratory secretions were requested. He was hospitalized for an etiological study. An infectious context with risk contact was identified: the patient`s mother had a chronic cough with 1 year of evolution and a maternal uncle had recently been hospitalized for pulmonary tuberculosis. The patient under study would have been called for tuberculosis screening but did not attend. In day 5 of hospitalization, for maintenance of intense headache with little relapse to the therapy of relief, and appearance of stiffness of the neck, a lumbar puncture was performed that allowed identification of Mycobacterium tuberculosis complex by the DNA PCR technique.
Conclusion: Tuberculosis meningitis is a rare disease with a challenging diagnosis due to its insidious evolution. Targeted treatment should be initialized as soon as possible.