Tuberculous meningitis complicated with thoracic cord myelitis; a diagnostic conundrum

Abstract

Tuberculosis is known as the great masquerader for its ability to present atypically. We report a case of a young man presented with progressive tuberculous meningitis and subsequently developed paraplegia due to thoracic cord myelitis, where diagnosis was confirmed bacteriologically. We highlight the presence of acute gastric dilatation as a warning sign of thoracic cord involvement and the place for CSF examination and spinal imaging in arriving at a clinical diagnosis, as treatment needs to start without delay to avoid permanent sequelae. Patient showed a good response to a combined approach of anti-tuberculosis treatment, systemic steroids and intravenous immunoglobulin.