A bstract Tubercular meningitis (TBM) and intracranial tuberculomas are severe central nervous system (CNS) manifestations of tuberculosis (TB). While TBM is more commonly reported in children, the coexistence of tuberculoma with TBM is rare and poses diagnostic and therapeutic challenges. Here, we report a case series describing five pediatric patients who presented with TBM with CNS TB between December 2024 and October 2025 in a tertiary care teaching institute of the southern part of rural Haryana. Five children aged 3–13 years presented with features of fever, headache, altered sensorium, neck stiffness, meningeal signs, seizures, and raised intracranial pressure. Neuroimaging revealed multiple intracranial tuberculomas along with radiological evidence of TBM (basal meningeal enhancement with mild communicating hydrocephalus). Cerebrospinal fluid analysis supports the diagnosis of TBM. All patients were initiated on anti-tubercular therapy (ATT) along with corticosteroids, glycerol/acetazolamide, and anti-convulsant with near-complete neurological improvement. Even though it is uncommon, co-occurring tuberculoma and TBM in children should be taken into account when making a differential diagnosis for pediatric CNS TB. Prompt neuroimaging and early initiation of ATT are critical to reducing morbidity.
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