A Case of Neurological Manifestations Accompanying Generalized Tuberculosis

Abstract

Najada Como, Esmeralda Meta, Drini Dobi, Dhimiter Kraja and Arjan Harxhi

Tuberculosis (TB), a multisystemic disease with variety presentations and manifestations, is the most common cause of infectious disease–related mortality worldwide [1]. A 23-year-old, male, is admitted to the Infectious diseases clinic “Mother Theresa” hospital in Tirana, after one year intermittent FUO and exudative pleural effusion treated first in Albania and then Italy. He had fever, back pain, muscular weakness, difficulty walking, urinary retention. In chest x ray radiological examination, CT scan of thorax and MRI of spinal cord are seen military form lesions, and vertebral destructions that raise suspicion of a possible pulmonary and extra pulmonary TB. The patient’s condition is randomly assigned to the beginning of antitubercular therapy (ATT), manifesting disturbance of conscience and coma. LCS results with 50 cells / mm3 and the CT scan of head detects hydrocephalus; funduscopia detected papilledema on 1st stage; which mean that the case is complicated with TB meningitis. The patient passes to the intensive care unit where ATT tapered cortisone, CNS diuretics and supportive therapy. After a week the patient comes out of the coma, begins his clinical improvement, but the neurological consequences of hydrocephaly and paraplegia become clearer. Two months later the patient was better clinically, walking with support .Peripheral neurological deficits persisted up to 10 months after leaving the hospital but with progressive improvement. The best ways to reduce mortality and morbidity associated with TBM are the timely diagnosis.

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