Disseminated Tuberculosis with Tuberculous Meningitis And Multisegmental Tuberculous Sponsylitis: A Case Report

Abstract

Background: The combination of tuberculous meningitis and tuberculous spondylitis as a manifestation of disseminated tuberculosis (TB) is a rarely reported condition often associated with poor clinical outcomes due to delayed diagnosis. This case report aims to highlight the importance of maintaining clinical suspicion for disseminated TB in patients presenting with a combination of neurological symptoms and chronic back pain. Case Presentation: A 30 year old woman presented with a 15 month history of progressive chronic low back pain radiating to both legs, which subsequently progressed to headache and altered consciousness. Neurological examination revealed signs of meningeal irritation, paraparesis, and sensory impairment at the T4 level. Imaging studies demonstrated multiple foci of tuberculous spondylitis and meningeal involvement, while cerebrospinal fluid analysis and molecular testing confirmed tuberculous meningitis. Based on the combnation of clinical manifestations, imaging findings, and ancillary tests, the patient was diagnosed with disseminated TB. She received anti-tuberculosis therapy, corticosteroids, and underwent a laminectomy with posterior fusion. Discussion: This case demonstrates that the combination of chronic back pain and progressive neurological symptoms should raise suspicion of disseminated TB, even though these manifestations rarely occur concurrently. Early diagnosis achieved through the integration of clinical, radiological, and microbiological findings enables appropriate multidisciplinary therapy, thereby contributing to improved clinical outcomes. Conclusion: Disseminated tuberculosis should be considered in patients presenting with a combination of neurological symptoms and chronic back pain. Clinical vigilance, early diagnosis, and adequate multidisciplinary management play a crucial role in improving the patient's prognosis and clinical outcomes.