Headache in a case of tuberculosis: think beyond meningitis—a case report

BACKGROUND: Intracranial hypertension may be idiopathic (IIH) or due to some underlying causes, such as an intracranial space-occupying lesion or drug induced. CASE PRESENTATION: A 14-year-old South Asian male was being treated for MDR-TB with anti-tubercular therapy (including levofloxacin) when he developed a headache lasting 8 days. Examination revealed bilateral papilledema. The CSF study was unremarkable. MRI revealed left transverse and sigmoid sinus stenosis. A probable diagnosis of levofloxacin-induced intracranial hypertension was made, and the drug was stopped. The symptoms resolved within 1 week of drug cessation, and the papilledema resolved within 2 weeks. CONCLUSIONS: Although rare, clinicians must be aware of this side effect of levofloxacin while evaluating a case with recent onset of features of raised ICP and taking this drug as part of some therapy.