Microbiologically Confirmed Concomitant Tuberculous and Pneumococcal Meningitis in an Adult: A Case Report

Concurrent infection of the central nervous system by Mycobacterium tuberculosis and Streptococcus pneumoniae is rare and poses substantial diagnostic and therapeutic challenges due to the overlap of clinical symptoms and cerebrospinal fluid (CSF) findings. A 45-year-old male presented with complaints of fever, headache, vomiting, generalized seizures, and altered sensorium. Magnetic resonance imaging of the brain was normal, and CSF analysis showed lymphocytic pleocytosis, protein elevation, and elevated levels of adenosine deaminase. A Cartridge-Based Nucleic Acid Amplification Test performed on the CSF detected Mycobacterium tuberculosis. CSF culture grew Streptococcus pneumoniae, confirming the diagnosis of both tuberculous and pneumococcal meningitis in the patient. The treatment included pathogen-directed intravenous antibiotics, tuberculosis treatment, corticosteroids, and comprehensive neurocritical care, including mechanical ventilation. The patient also suffered from ventilator-associated pneumonia due to Klebsiella pneumoniae, which was managed successfully. The patient made steady neurological improvement, was weaned off mechanical ventilation, and was discharged. This case illustrates that diagnosing combined tuberculous and bacterial meningitis remains challenging, and laboratory confirmation of a single infection does not exclude additional pathogens or etiologies, especially in countries with prevalent tuberculosis. Comprehensive CSF evaluation using both molecular diagnostics and conventional culture enabled timely diagnosis and pathogen-directed therapy. This case highlights the importance of maintaining a high index of suspicion for dual central nervous system infections and integrating molecular diagnostics with conventional microbiological techniques to facilitate early pathogen-directed therapy.