TUBERCULOUS MENINGOENCEPHALITIS: A CASE REPORT

Tuberculous Meningoencephalitis (TBME) is a severe manifestation of extrapulmonary tuberculosis, frequently associated with delayed diagnosis due to the nonspecific nature of early symptoms. This case report describes a 46-year-old man residing in Uruará, western Pará, previously healthy, who in May 2024 developed continuous fever, dry cough, and progressive exertional dyspnea. He sought medical care at a local hospital, where he was diagnosed with community-acquired pneumonia and admitted for intravenous antibiotic therapy. During hospitalization, he developed a loculated right pleural effusion, requiring chest drainage with more than two liters of pleural fluid collected. Despite treatment, he persisted with afternoon fever and residual dyspnea. He was discharged with oral antibiotics and outpatient follow-up. At home, he developed intense headache, asthenia, visual blurring, and neurological alterations, progressing to brief tonic–clonic seizures and decreased level of consciousness. Due to lack of response at the hospital in Uruará, he was referred to the Regional Hospital in Santarém (PA), where neurological investigation was initiated. After initial evaluation and stabilization, contrast-enhanced brain MRI revealed diffuse meningeal enhancement suggestive of infectious process. Electroencephalography showed diffuse epileptiform activity, and cerebrospinal fluid obtained by lumbar puncture demonstrated lymphocytic pleocytosis, hyperproteinorrachia, and hypoglycorrhachia, with PCR positive for Mycobacterium tuberculosis . With these findings, TBME was diagnosed. Treatment was initiated with the classic antituberculous regimen (isoniazid, rifampicin, pyrazinamide, and ethambutol), associated with systemic corticosteroid therapy using dexamethasone. The patient remained hospitalized for 26 days, with progressive clinical improvement and control of neurological manifestations. This report highlights the importance of continuous professional training for early diagnosis of extrapulmonary tuberculosis, aiming to prevent irreversible neurological complications and reduce morbidity and mortality, especially in endemic and resource-limited areas. CAAE No. 90103125.7.0000.0334, registered on Plataforma Brasil.