Diagnosis of urinary retention in a child with tuberculous meningitis in a resource-limited setting: a rare case report

Background: Urinary retention in pediatric meningitis, particularly tuberculous meningitis (TBM), is an exceptionally rare clinical manifestation. In resource-constrained environments, confirmatory diagnostic procedures such as bone marrow aspiration and culture are often inaccessible, complicating the timely identification of TBM. Early recognition is vital, especially when patients present with atypical symptoms like urinary retention, to ensure prompt and targeted treatment. This report highlights a rare case of urinary retention in a child with suspected TBM in a limited-resource setting. Case Presentation: A 7-year-old boy presented with lower abdominal pain and an inability to urinate for the past 10 hours. He also had a history of fever and headache for 18 hours and a persistent cough lasting three weeks. Abdominal examination suggested bladder fullness, although ultrasonography was unremarkable. A thoracic X-ray indicated pulmonary tuberculosis, supported by a positive molecular rapid test for Mycobacterium tuberculosis. A CT scan of the brain showed meningeal enhancement consistent with TBM. The patient was diagnosed with suspected tuberculous meningitis accompanied by urinary retention and began anti-tuberculosis therapy combined with corticosteroids. The urinary symptoms improved significantly during hospitalization. Conclusion: This case illustrates the importance of recognizing urinary retention as a potential, albeit rare, symptom of TBM in pediatric patients. In settings with limited diagnostic tools, clinicians must rely on clinical judgment and accessible investigations to initiate early treatment. Awareness of uncommon presentations such as meningitis-retention syndrome is crucial for improving outcomes in children with TBM.