A Complicated Case of Central Nervous System Tuberculosis in an Immuno Competent 25 year old Female with Visual Hallucinations and Blindness: Lessons Learned from a Rare Entity

Abstract

Tuberculosis (TB) is a leading cause of the death in low-income countries, and central nervous system-TB (CNS-TB) is one of the most devastating variants of TB. A spectrum of symptoms can occur, ranging from nonspecific and heterogeneous to focal signs in the form of neurological complications. This case report describes a case of CNS-TB in a 25-year-old woman who presented with headache, fever, malaise, and generalized weakness of the lower extremities, followed by an unresponsive state. The patient was diagnosed with tubercular meningitis, and started on anti-tubercular therapy (ATT). Within days of inpatient treatment, the patient deteriorated rapidly, developing blindness with paraplegia and subsequently psychiatric symptoms in the form of visual hallucinations. Psychiatric symptoms were completely resolved with short-term treatment with antipsychotics. The patient had an uneventful recovery with the help of ATT and psychological support sessions, and had regular follow-ups for the next 8 months. This case focused on the differential diagnostic propensities of the index subject, who presented with CNS-TB (on ATT), visual hallucinations, and blindness during the inpatient stay. A clinician must be aware of unusual presentation of CNS-TB and other different causes of visual hallucinations for early diagnosis and prompt treatment of the patient.