Tuberculous Meningitis Presenting with Bilateral Optic Neuritis: A Case Report and Review of Literature.

Introduction: Tuberculosis (TB) is a major global cause of morbidity and mortality. TB meningitis (TBM) is an implication of systemic dissemination of a primary TB infection that indicates a poorer disease prognosis with various long-term neurological sequelae. Consequently, it is crucial to understand the different clinical presentations and manifestations of such condition. In TBM, vision loss, which is one of the most devastating complications, may result from optic nerve inflammation and atrophy. Although unilateral optic neuritis as a primary presenting symptom of TBM has been broadly reported in the literature, there is a paucity of information related to several other rare neuro-ophthalmic features, such as bilateral optic nerve involvement in TBM. Case Presentation: We herein present a case of a 37-year-old Indian male patient presenting with unilateral vision loss that subsequently progressed to bilateral vision loss and was hence diagnosed with bilateral optic neuritis. Additional thorough investigation yielded a diagnosis of TBM with underlying tuberculomas. The patient's condition improved afterward with anti-tuberculous therapy and steroids with follow-up magnetic resonance imaging indicating radiological resolution as well. Conclusion: The differential diagnosis of bilateral optic neuritis is broad but rare, yet an overlooked one would be central nervous system TB in the form of meningitis or tuberculoma. Hence, it is important to identify bilateral optic neuritis as a possible rare presenting symptom of an underlying central nervous system TB infection which could lead to a faster disease diagnosis and treatment to prevent its devastating complications.