A simultaneous case miliary tuberculosis presenting with tuberculous meningitis: a case report

Background: Miliary tuberculosis in children could occur 20-40% simultaneously with tuberculous meningitis (TBM). Dissemination of the tuberculous bacilli from the lungs to the meninges leads to the formation of small tuberculomas, leading to TBM. Despite the availability of effective therapy, diagnosis is usually late, and mortality remains high. Case Presentation: A 15-year-old boy came to our emergency ward with the chief complaint of loss of consciousness two days before admission. The patient had a fever in the past month. Fever occurred in several episodes along with cough. The patient had a headache five days before admission. Projectile vomiting was denied. The patient had lost about five kilograms in the last month. Vital signs are stable and within normal limits. Physical examination showed lethargy, neck stiffness, and an enlarged lymph node on the neck. Neurologic examination was normal. Chest X-ray showed miliary opacities scattered over both lung fields. Cerebrospinal fluid (CSF) examination showed clear with low glucose and high cell count suggested to TBM. No bacteria were found in the CSF culture sample. A contrast head computed tomography (CT) scan revealed a leptomeningeal contrast enhancement. Active communicating hydrocephalus was also seen on a head CT scan. Eventually, Mycobacterium was detected in the gastric fluid. The patient was diagnosed with tuberculous meningitis. This patient was treated in an intensive phase of anti-tuberculous therapy and continued with an advanced phase. Conclusion: We reported cases of miliary tuberculosis simultaneously with tuberculous meningitis in a 15-year-old patient. The timely diagnosis and management will reduce morbidity and mortality.