Tuberculous meningitis in a former inmate, a case report

Introduction: tuberculous meningitis is the most severe form of extrapulmonary tuberculosis, with mortality rates approaching 50%. Neurological damage is primarily driven by dysregulated host neuroinflammatory responses following the invasion of the central nervous system by Mycobacterium tuberculosis.Case report: A case is presented of a 45-year-old male, a former inmate, with a one-month clinical course characterized by constitutional symptoms, headache, and progressive neurological impairment. Physical examination revealed meningeal syndrome and sixth cranial nerve palsy. Cerebrospinal fluid analysis showed lymphocytic pleocytosis (410 cells/mm³, 88% lymphocytes), hyperproteinorrachia (260 mg/dL), and hypoglycorrachia (18 mg/dL). The diagnosis was confirmed via GeneXpert and neuroimaging, which evidenced basal leptomeningeal enhancement and hydrocephalus. Treatment was initiated with the HRZE regimen and adjuvant dexamethasone, achieving significant clinical improvement after 35 days of hospitalization. Discharge was coordinated to complete the total planned duration of antituberculous treatment through the Directly Observed Treatment, Short-course (DOTS/TAES) program. At the time of discharge, the patient was oriented and able to walk with minimal assistance, with the sixth cranial nerve palsy showing signs of progressive improvement.Conclusions: early diagnosis based on epidemiological and clinical suspicion is vital. Timely management with antitubercular drugs and corticosteroids significantly reduces mortality and permanent sequelae.