Neurotuberculosis in a paediatric patient: a case report

Abstract

Introduction: Central nervous system tuberculosis is a severe form of extrapulmonary involvement, with high risk of death and other unfavorable outcomes, particularly in children. Health professionals must be prepared to recognize symptoms and maintain a high degree of suspicion. Objective: To report a case of a pediatric patient with central nervous system tuberculosis, documenting clinical manifestations, complementary tests, diagnosis, treatment, and main outcomes. Case description: A previously healthy 10-year-old male presented with a two-month history of right parieto-occipital headache, associated with somnolence, blurred vision, nausea, vomiting, fever, and generalized tonic-clonic seizure. Neuroimaging revealed multiple ring-enhancing lesions in the right cerebellar hemisphere, associated with vasogenic edema and mass effect. Cerebrospinal fluid analysis showed 85 cells/mm³ with lymphocytic predominance, glucose 31 mg/dL, protein 120 mg/dL, and a rapid molecular test detecting traces of M. tuberculosis DNA. Treatment was initiated with rifampicin, isoniazid, pyrazinamide, and ethambutol, along with corticosteroid therapy. The patient showed progressive clinical improvement and maintained adherence throughout the treatment. Discussion: The prognosis of central nervous system tuberculosis is generally unfavorable, with high mortality and permanent sequelae rates. However, with appropriate treatment, complete clinical recovery may occur. This highlights the importance of surveillance for central nervous system tuberculosis in children, particularly in regions with high tuberculosis prevalence, in order to reduce diagnostic delays and improve patient outcomes.