Tuberculosis is the second leading cause of death under the category of
infectious diseases, after the human immunodeficiency virus (HIV). Tuberculous meningitis
(TBM) constitutes about 5% of all extrapulmonary disease worldwide. This report describes a case
of Tuberculous meningitis with rare presentation in a 28-year-old woman, who was treated based
on a collection of her social background, clinical findings and Multiplex PCR of tuberculosis.
A 28-year-old Malay woman with no significant medical history
presented to HUSM with one month history of on and off fever, two weeks history of generalised
limbs weakness and one week history of dysphagia. She was reported to have experienced visual
hallucination and significant weight loss. Her laboratory result is significant for leukocytosis,
elevated ESR and hypernatremia. Non-enhanced and contrast CT scan of the brain showed
severe bilateral frontal cerebral atrophy. Cerebral spinal fluid (CSF) for multiplex PCR for
complex was positive. She was promptly started on anti-TB regime
combined with dexamethasone. Subsequent follow-up showed significant improvement.
This is a rare clinical manifestation of Tuberculous meningitis that
demonstrates the importance of recognising and initiating the treatment early to reduce
disabilities and improve clinical outcome.