A case of tuberculous meningitis triggered by long-term use of corticosteroids drugs.

Introduction and importance: Tuberculous meningitis (TBM), caused by Mycobacterium tuberculosis, is a severe central nervous system infection prevalent in areas with a high incidence of tuberculosis. Dissemination frequently takes place among children and young adults within particular regions.

Case presentation: A 25-year-old woman from East Sudan presented with headache, neck pain, fever, anxiety, and hemodynamic instability. Despite no prior history of tuberculosis or known contact with affected individuals, her diagnosis of TBM was confirmed based on clinical presentation, radiological findings (notably leptomeningeal enhancement), and a positive response to anti-tuberculosis therapy.

Clinical discussion: This case highlights the importance of immunosuppressive therapy as a risk factor, as the patient had been on a prolonged course of corticosteroids (dexamethasone) at a dose of 15 mg/day for 6 months. This atypical presentation emphasizes the relevance of TBM in patients with prolonged symptoms of meningitis that do not respond to standard treatment, especially those with a history of immunocompromising diseases or drugs.

Conclusion: This case demonstrates the serious implications of inappropriate corticosteroid usage, as well as the crucial importance of early diagnosis and treatment of TBM to avoid life-threatening complications. It serves as a reminder of the significance of remaining vigilant for TBM in areas where tuberculosis is endemic.