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Case report
Fatal tuberculous meningitis in an infant presenting with seizures in the UK
  1. Nisreen Khambati1,2,
  2. Mimi Hou3,
  3. Dominic Kelly4,5 and
  4. Rinn Song2,4
  1. 1Department of Paediatrics, Buckinghamshire Healthcare NHS Trust, Amersham, Buckinghamshire, UK
  2. 2Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, Oxfordshire, UK
  3. 3The Jenner Institute, University of Oxford, Oxford, UK
  4. 4Department of Paediatrics, Oxford University Hospitals NHS Trust, Oxford, Oxfordshire, UK
  5. 5NIHR Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK
  1. Correspondence to Dr Nisreen Khambati; nisreen.khambati{at}conted.ox.ac.uk

Abstract

A 5-month-old male child of European background presented with sudden onset of prolonged afebrile seizures. He was intubated and transferred to the paediatric intensive care unit where he displayed abnormal neurology and remained ventilated. Brain MRI showed basal leptomeningeal enhancement suggesting malignancy or infection. Subsequent cerebrospinal fluid results of lymphocytic pleocytosis and raised protein were suggestive of tuberculous (TB) meningitis and anti-TB treatment was commenced empirically. Positive TB microbiology was eventually confirmed on respiratory secretions. The infant continued to show abnormal neurologic findings and repeated neuroimaging showed a new extensive cerebral infarct. The infant was compassionately extubated and passed away. The father was later found to have pulmonary TB. This case is an important reminder of TB meningitis for countries where TB is uncommon. The importance of considering TB in any child with abnormal neurology and of taking prompt family histories to identify children at risk is highlighted.

  • meningitis
  • TB and other respiratory infections
  • paediatric intensive care
  • epilepsy and seizures

https://doi.org/10.1136/bcr-2021-243573

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    Footnotes

    • Contributors NK and RS identified the case and planned the article. MH and DK were directly involved in patient care. NK did the literature review. NK and MH prepared the initial manuscript. DK and RS provided expert review and revision of the manuscript and contributed equally to the paper.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.