NON-SPECIFIC HEADACHE AS THE MAIN MANIFESTATION OF TUBERCULOUS MENINGITIS: A RARE CASE REPORT

Introduction: Tuberculous meningitis (TBM) is the most severe form of extrapulmonary TB, posing a major public health challenge due to high morbidity and mortality. Non-specific symptoms and limited diagnostic access delay detection, worsening patient outcomes. Headache, as one of the non-specific symptoms of TB meningitis, often leads to misdiagnosis Case Report: Male, 31 years old, presented with a persistent headache as the primary symptom, without definite fever, neck stiffness, or altered mental status. Initial cerebrospinal fluid (CSF) analysis showed no significant abnormalities, delaying diagnosis. GeneXpert MTB/RIF later confirmed Mycobacterium tuberculosis, and the patient was diagnosed with tuberculous meningitis (TBM). Follow-up imaging revealed persistent meningeal enhancement, leading to an extended treatment duration. The patient showed clinical improvement after completing 12 months of anti-tuberculosis therapy. Discussion: The diagnosis of tuberculous meningitis (TBM) remains challenging due to its non-specific clinical presentation and overlap with other central nervous system (CNS) disorders. Delays in diagnosis often arise from non-specific headache (reported in over 50% of cases, typically presenting with a holocranial and throbbing pattern), unexplained fever, absence of classic meningeal signs, and inconclusive initial cerebrospinal fluid (CSF) findings. Early and accurate diagnosis relies on a comprehensive approach integrating CSF analysis, molecular diagnostics, and neuroimaging. Persistent imaging abnormalities may necessitate extended treatment beyond the standard duration in certain cases. Conclusion: Non-specific symptoms, such as headache, often lead to a delayed diagnosis of TBM, requiring CSF analysis, molecular testing, and neuroimaging. While a 12-month treatment course is standard, further research on advanced imaging and artificial intelligence is essential to improve TBM detection and management.