Fatal Tuberculous Meningitis With Hydrocephalus and SIADH (Syndrome of Inappropriate Antidiuretic Hormone Secretion) in an Immunocompetent Adult With Miliary Tuberculosis: Diagnostic Challenges Associated With Language Barriers

Tuberculous meningitis is a severe manifestation of disseminated tuberculosis associated with high morbidity and mortality. I report the case of a 30-year-old previously healthy immunocompetent immigrant who initially presented with fever, malaise, and rhinorrhoea. A significant language barrier limited history-taking, contributing to diagnostic delay. His condition rapidly progressed to acute hydrocephalus and syndrome of inappropriate antidiuretic hormone secretion (SIADH) in the context of concomitant miliary pulmonary tuberculosis. Despite prompt initiation of anti-tubercular therapy, high-dose corticosteroids, and neurosurgical intervention, his neurological status deteriorated, and he succumbed within a short period. This case highlights the importance of early recognition of tuberculous meningitis and its potentially life-threatening complications, particularly among patients from tuberculosis-endemic regions where the disease remains prevalent. It also underscores how communication barriers in healthcare may delay diagnosis and worsen outcomes, especially in countries like the United Kingdom, where tuberculosis is relatively uncommon.