Navigating complex presentations of central nervous system tuberculosis: A two-case analysis

Tuberculosis (TB) remains a significant global health concern, and the COVID-19 pandemic has negatively impacted TB control. This report presents 2 challenging cases of central nervous system (CNS) tuberculosis with atypical presentation in adult patients. The first case involved a young male patient with disseminated tuberculosis who presented with meningoencephalitis, multiple brain abscesses, vasculitis, and extensive myelopathy, resulting in paraplegia. The patient required multiple neurosurgical interventions and experienced complications such as drug-induced hepatotoxicity and neurogenic bladder. The second case describes an elderly male patient with an oncological history of tuberculous meningitis that mimicked tumor dissemination and presented with multiple hemorrhagic intraventricular nodular lesions. In both cases, the integration of advanced neuroimaging techniques and molecular methods, such as PCR for Mycobacterium tuberculosis in the cerebrospinal fluid, was crucial for confirming the diagnosis. Despite the early initiation of anti-tuberculosis therapy and steroids, both patients experienced significant residual neurological morbidity. These cases highlight the importance of considering tuberculosis in the differential diagnosis of atypical neurological lesions, even in immunocompetent patients, and the need for rapid diagnostic tests to reduce complications and permanent sequelae of the disease. A multidisciplinary approach and close follow-up are essential for managing complex cases of CNS tuberculosis.