Unveiling the Dual Culprit: Central Nervous System Tuberculosis Mimicking Acute Hemorrhagic Encephalitis

Tuberculosis (TB) is the oldest known infectious disease and the top cause of death worldwide. Central nervous system (CNS) TB can present in many forms, but the most common ones are tubercular meningitis, hydrocephalous, and tuberculoma. CNS TB presenting as multiple cortical and subcortical, white and gray matter hemorrhagic lesions can be called acute hemorrhagic leukoencephalitis, which is the rarest. Acute hemorrhagic encephalitis (AHE) is a rare but severe autoimmune demyelinating disorder of the CNS, often categorized under the broader syndrome of acute demyelinating encephalomyelitis. While typically associated with viral infections or vaccination, its occurrence in conjunction with tubercular meningitis is exceedingly rare. We present a case where a patient with tubercular meningitis presented as AHE. This case highlights the diverse manifestations of tubercular CNS infections, which can mimic other neurological conditions, and underscores the necessity for a comprehensive diagnostic approach in cases of acute neurological deficits.