Unveiling the Uncommon Ventriculitis in Tubercular Meningitis

Tubercular (TB) meningitis is one of the manifestations of central nervous system tuberculosis, a form of extrapulmonary tuberculosis. Despite the high incidence of TB meningitis in developing countries, there are hardly any reports of associated ventriculitis, making it one of the rare complications. Ventriculitis complicating TB meningitis is devastating not only to the immunocompromised but also to the immunocompetent population. The diagnosis of TB meningitis is indeed challenging, owing to the clinical similarities with other types of meningitis and laboratory techniques that are rather insensitive and slow. Thus, this under-recognized complication can impact the morbidity and mortality of the people affected by it, making it imperative for it to be diagnosed and managed early. We present a case of a 52-year-old man with no known comorbidities, who presented with fever, chills, headache, vomiting, and altered mental status for four days, and showed a Glasgow Coma Scale (GCS) score of 8 (E2V2M4), stiffness of the neck, sluggishly reactive pupils, and tachycardia on arrival. The pathological findings, including CSF analysis, MRI, and cartridge-based nucleic acid amplification test (CBNAAT), diagnosed the case as TB ventriculitis with meningitis. The patient was mechanically ventilated and then treated with anti-TB treatment and steroids. The case thus illustrates a rare and challenging presentation of TB meningitis that can present with a variety of neurological sequelae and complications, including ventriculitis, as in this case, which can have devastating consequences if left untreated. It can result in persistent neurological sequelae, hydrocephalus, and prolonged hospital stay. Hence, our case highlights the need for a timely diagnosis and treatment that can help improve the prognosis, thereby reducing morbidity and mortality.