Left cerebellar abscess - a rare presentation of tubercular meningoencephalitis in childhood

Tuberculous meningitis (TBM) is a life-threatening manifestation of extrapulmonary tuberculosis, commonly seen in developing countries. It predominantly affects the leptomeninges and accounts for 5–15% of extrapulmonary TB cases. While tuberculomas are frequent intracranial complications, cerebellar abscesses are exceedingly rare, especially in paediatric and immunocompetent populations. We report a rare case of a 10-year-old male who presented with fever, headache, vomiting, altered sensorium, and hearing loss. Neurological examination revealed signs of raised intracranial pressure, cerebellar involvement, and meningitis. Magnetic resonance imaging (MRI) imaging demonstrated a large left cerebellar abscess with surrounding edema and obstructive hydrocephalus. Cerebrospinal fluid (CSF) analysis supported the diagnosis of TBM, and GeneXpert testing confirmed Mycobacterium tuberculosis. The patient was managed with anti-tubercular therapy (ATT), corticosteroids, and supportive measures, including mannitol and acetazolamide. Neurosurgical intervention involved emergency external ventricular drainage and stereotactic aspiration of the abscess. This case highlights the importance of early recognition and combined medical-surgical management of rare TB-related CNS complications to prevent permanent neurological deficits. To our knowledge, only three paediatric cases of cerebellar tubercular abscesses have been reported in the literature to date, emphasizing the rarity and clinical significance of this presentation.