MULTIPLE MENING AND BRAIN INVOLVEMENT REVEALING MULTIFOCAL TUBERCULOSIS IN A YOUNG IMMUNOCOMPETENT PATIENT: CASE REPORT

Goal: To report the case of an immunocompetent patient with tuberculous infection in the lungs, meninges, kidney and sacroiliac joint. Detail of the case: A 19-yearold female patient, with previous poorly explained syncope and convulsive episodes, presented to the emergency room with severe headache in the frontal and biparietal region, accompanied by photophobia, phonophobia and emesis. On admission, the physical examination revealed mental confusion, she was afebrile and agitated. The patient evolved with worsening neurological symptoms, impaired focal deficits, left esotropia and decreased cognition. Contrastenhanced computed tomography of the abdomen and chest was performed in which the hypothesis of miliary tuberculosis was raised and after verifying findings suggestive of hematogenous dissemination, the diagnosis of multifocal tuberculosis was confirmed, and a tuberculostatic scheme based on quadruple therapy with rifampicin, isoniazid, ethambutol and Pyrazinamide was started, and the patient was then referred to the municipal referral service for Tuberculosis, after clinical stabilization. Final considerations: Tuberculous meningitis is a potentially lethal and rare disease, especially in immunocompetent patients. This nonspecific picture can have its genesis in several brain pathologies, which makes imaging and Cerebrospinal Fluid exams essential for diagnostic confirmation.