Abstract

Tuberculous meningitis is a severe manifestation of extrapulmonary tuberculosis, often associated with substantial morbidity and mortality. This case report discusses a unique presentation of tuberculous meningitis in a 39-year-old male who was concurrently positive for COVID-19. The patient initially presented with symptoms of COVID-19, including fatigue, fever, and respiratory distress. However, subsequent neurological symptoms, including facial asymmetry, ptosis, and dysphagia, led to further evaluation. Imaging and cerebrospinal fluid analysis confirmed the diagnosis of tuberculous meningitis. Treatment involved a multidrug regimen and supportive care in an intensive care unit. The patient was eventually discharged with residual neurological deficits. This case emphasizes the importance of considering tuberculous meningitis in the context of COVID-19, particularly in regions with a high burden of tuberculosis. Timely diagnosis, through clinical evaluation and diagnostic tools such as cerebrospinal fluid analysis and radiographic imaging, is crucial for effective management. The potential risk of TB reactivation in COVID-19 patients underscores the need for continued vigilance and prompt intervention to prevent severe disease outcomes.

Key words: Covid-19, tuberculous meningitis, reactivation