SHM Converge Scientific Abstract ePoster Gallery-Missed Connections: A Diagnostically Challenging Tuberculosis Meningitis Case

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This case report describes a 35-year-old man from Mauritania who presented with 2 weeks of headache and 3 weeks of abdominal pain, plus nausea, vomiting, reduced appetite, constipation, and a recent history of fever, chills, and intermittent cough. Initial evaluation was unrevealing, and his symptoms were treated as migraine and gastrointestinal illness during prior emergency visits without improvement. Communication was difficult because of a dialect-based language barrier, and the patient’s neurologic decline was not fully recognized until family collateral history clarified his baseline and worsening condition.<br /><br />Imaging initially showed an atypical left pleural-based lesion and pneumomediastinum, which complicated the differential diagnosis. After a positive QuantiFERON-TB Gold test and worsening clinical status, a stroke alert revealed a right internal capsule infarct. MRI of the brain then demonstrated basilar leptomeningeal enhancement, multiple acute-subacute infarcts, and lesions consistent with tuberculomas. Cerebrospinal fluid studies supported tuberculous meningitis, showing hypoglycorrhachia, elevated protein, elevated white blood cells, and increased opening pressure. The patient was HIV negative but had epidemiologic risk from an endemic TB region and had unexplained weight loss.<br /><br />The authors emphasize that extrapulmonary tuberculosis can present without classic pulmonary symptoms and may manifest as meningitis, pleural tuberculoma, or both. Because tuberculous meningitis often develops subacutely, diagnosis and treatment are frequently delayed, increasing morbidity and mortality risk. The report highlights the importance of maintaining a broad differential diagnosis, interpreting seemingly unrelated findings as potentially linked, and obtaining reliable collateral history when language barriers or subtle mental status changes obscure the clinical picture.

Asset Subtitle

Zamia C. Diaz

Meta Tag

Author List Jacob Zinn, Zamia C. Diaz

Category Clinical Vignettes

Concept Extrapulmonary Tuberculosis

Concept Tuberculous Meningitis

Concept Altered Mental Status

Concept CSF Abnormalities

Concept Leptomeningeal Enhancement

Distinguished Non-Finalist

Presenter Organization Penn Medicine

Presenting Author Zamia C. Diaz

Track Adult

Keywords

tuberculous meningitis

extrapulmonary tuberculosis

basilar leptomeningeal enhancement

cerebral infarction

tuberculoma

pleural lesion

QuantiFERON-TB Gold

language barrier

collateral history

Mauritania

Extrapulmonary Tuberculosis

Tuberculous Meningitis

Altered Mental Status

CSF Abnormalities

Leptomeningeal Enhancement