Tubercular Meningoencephalitis with Longitudinal Extensive Transverse Myelitis (LETM): A Clinical Dilemma

Tuberculosis remains a significant global health challenge with various clinical presentations. In this case, we present a rare occurrence of disseminated tuberculosis with meningoencephalitis with longitudinally extensive transverse myelitis (LETM) in an immunocompetent person, which illustrates its complex clinical course and the challenges associated with diagnosis. A 24-year-old male patient presented with progressive weakness in the proximal lower limbs which was associated with acute urinary retention, followed by fever, headache, neck pain, and projectile vomiting. Neurological examination revealed neck rigidity, decreased sensations, paraparesis, and absent deep tendon reflexes. Cerebrospinal fluid analysis indicated lymphocytic pleocytosis and elevated protein levels. Radiological findings confirmed the presence of meningoencephalitis with LETM. However, the magnetic resonance imaging (MRI) findings in the brain and LETM in the spinal cord were suggestive of an autoimmune association, and neuromyelitis optica spectrum disorder (NMOSD) could not be ruled out. Based on the clinical, laboratory, and radiological evidence, a diagnosis of disseminated tuberculosis was established. The patient was promptly initiated on steroids and antitubercular treatment. This case serves as a reminder of the diverse clinical spectrum associated with tuberculosis, highlighting the importance of considering unusual presentations. Early diagnosis is an important predictor for prognosis which prevents complications and improves patient outcomes.