Tubercular Ventriculitis

Central nervous system tuberculosis (TB) is one of the most precarious forms of extrapulmonary TB, and frequent manifestations include meningitis, ventriculitis, cerebral abscesses, and parenchymal tuberculomas. A 70-year-old female presented to the emergency department with fever and vomiting for 15 days, followed by an acute decline in the sensorium over the past 2 days. Her cerebrospinal fluid (CSF) analysis depicted an elevated cell count with lymphocytic predominance, low sugar levels, raised protein levels, and normal adenosine deaminase levels. Further, she underwent magnetic resonance imaging of the brain, which revealed meningitis along with ventriculitis, and later, the CSF cartridge-based nucleic acid amplification test came back positive for Mycobacteriumtuberculosis. The patient was immediately started on high-dose intravenous steroids (dexamethasone) along with oral antitubercular drugs. This made a great improvement in the sensorium, and after 16 days of inpatient management, the patient was discharged in a fully conscious state.