Challenging diagnosis of central nervous system tuberculosis with joint involvement

Challenging diagnosis of central nervous system tuberculosis with joint involvementCentral nervous system tuberculosis (CNS-TB) is a rare but severe form of extrapulmonary tuberculosis that can mimic various neurological conditions, making diagnosis challenging.We aimed to present a 70-year-old male patient who initially had non-specific symptoms, including dyspnea, malaise, and dizziness.His condition progressed to confusion and seizure, raising suspicion of central nervous system involvement.Initial imaging findings were inconclusive, and multiple diagnostic tests, including pleural fluid and joint biopsy, were negative for Mycobacterium tuberculosis.However, cerebrospinal fluid analysis confirmed CNS-TB through Xpert MTB/RIF polymerase chain reaction.Despite prompt initiation of anti-tuberculous treatment and intensive care support, the patient's condition worsened, and he succumbed to the disease.This case highlights the diagnostic difficulties associated with CNS-TB and underscores the importance of maintaining a high clinical suspicion in endemic regions, even when initial diagnostic tests are negative.