Multiple cranial neuropathy secondary to tuberculous meningitis and intracranial tuberculoma in an adolescent

Neurotuberculosis –a severe form of extrapulmonary tuberculosis– accounts for approximately 1% of all cases and is a frequent cause of neurological disability in developing countries. Tuberculous meningitis, the most common form, primarily affects children under 5 years of age, immunocompromised individuals, and HIV-positive patients, although it can also occur in otherwise healthy adolescents. Early detection and timely treatment are essential to reduce morbidity and mortality. The patient, a 17-year-old adolescent girl, presented with holocranial headache, fever, blurred vision, and somnolence, progressing to paralysis of the III and VI cranial nerves, without classical signs of early meningitis. Brain magnetic resonance imaging revealed hyperintense nodular lesions on T2-FLAIR sequences in the head of the left caudate nucleus and intraventricularly in the septum pellucidum, with ring enhancement after contrast administration, consistent with tuberculomas. Cerebrospinal fluid analysis showed lymphocytic pleocytosis, elevated protein levels, and low glucose concentration. Diagnostic confirmation was achieved through a positive Xpert™ MTB/RIF test on cerebrospinal fluid for Mycobacterium tuberculosis. Clinical improvement was observed following antituberculous therapy and corticosteroids. This case highlights the importance of considering neurotuberculosis in patients with subacute neurological symptoms, even in adolescents without evident risk factors. Early identification and appropriate treatment are crucial to prevent severe neurological sequelae and improve outcomes.