DELAYED DIAGNOSIS OF TUBERCULOUS LEPTOMENINGITIS COMPLICATED BY MULTISYSTEMIC MORBIDITIES IN A KENYAN HOSPITAL

Tuberculous meningitis (TBM) is the most severe and uniformly fatal form of extrapulmonary tuberculosis without treatment. HIV co-infection is the most serious risk factor of TBM in sub-Saharan Africa. The diagnosis of TBM is fraught with many patient and health system challenges, leading to treatment delays and serious TBM-related morbidity and mortality. These include a lack of resources for adequate TB diagnostics, lack of adequate knowledge on typical and atypical TB presentations, over-reliance on bacteriological methods to confirm TB diagnosis, and failure to consider TB in the absence of available diagnostic methods in the face of compatible clinical characteristics. The World Health Organization (WHO) recommended the use of Xpert/MTB/Rif as the initial diagnostic test for TBM in 2013, but the sensitivity rates for cerebrospinal fluid diagnosis of TBM vary from 59% to 72% depending on the methodology used. In this study, we report on the case of a young high school student in rural Kenya whose TBM diagnosis and treatment were delayed by 2 years, leading to significant disease-related morbidity. Her subsequent presumptive diagnosis of TBM and treatment with anti-TB drugs, adjunctive corticosteroids, and supportive care led to the resolution of almost all her complications. We emphasize the need for empirical TBM treatment in appropriate clinical circumstances