A case report about a child with drug-resistant tuberculous meningitis

Abstract Background: Hematogenous disseminated pulmonary tuberculosis predisposes to concurrent tuberculous meningitis (TBM), the most devastating and disabling form of tuberculosis. However, children often have atypical clinical symptoms, difficulty in specimen collection, low specimen content, and the increasing incidence of drug-resistant tuberculosis, which makes the accurate diagnosis and timely treatment of childhood tuberculosis face monumental challenges. Case presentation: The 14-year-old female, was admitted to the hospital with intermittent fever, headache, and blurred vision, her cerebrospinal fluid (CSF) examination showed a lymphocytic pleocytosis, elevated protein level, decreased chloride level, positive for TB-RNA, Xert MTB/RIF detected Mycobacterium tuberculosis, but rifampin resistance test was unknown. Subsequently, her CSF culture was positive for Mycobacterium tuberculosis, and the drug sensitivity test (DST) revealed resistance to isoniazid, rifampin, and fluoroquinolones. Computed tomography (CT) of the chest showed diffuse miliary nodules in both lungs. Intracranial enhanced magnetic resonance imaging (MRI) showed “multiple intensified images of the brain parenchyma, cisterns, and part of the meninges.”The final diagnosis is hematogenous disseminated pulmonary tuberculosis and pre-extensive drug-resistant TBM. After 19 months of full oral individualized antituberculosis treatment, her infection was effectively controlled with no neurological sequelae. Conclusion: For patients with hematogenous disseminated pulmonary tuberculosis, especially children, even if there are no typical clinical symptoms, it is necessary to know whether there is TBM and other conditions, and constantly look for the relevant aetiological basis to clarify whether it is drug-resistant tuberculosis, to achieve a rapid and accurate diagnosis and timely and effective treatment, which can effectively improve prognosis and reduce mortality and disability rate.