CASE REPORTS: NEUROTUBERCULOSIS, DIAGNOSTIC CHALLENGE IN IMMUNOCOMPETENT PATIENTS

Abstract

Tuberculosis (TB) remains a significant global public health challenge since its declaration as a global epidemic by the World Health Organization in 1993. In particular, extrapulmonary TB, which includes neurotuberculosis — a rare and severe form that affects the central nervous system (CNS) — presents unique challenges. Although commonly associated with immunocompromised individuals, neurotuberculosis can also present in immunocompetent patients, often with nonspecific symptoms that lead to delays in diagnosis. This article discusses three cases of neurotuberculosis in immunocompetent patients without pulmonary involvement, highlighting the complexity of diagnosing this condition due to its insidious clinical presentation. The rarity of CNS involvement, reported in only 1 to 5% of TB cases, underlines the need for increased clinical suspicion and early diagnostic interventions to prevent serious neurological sequelae. The study emphasizes the need for comprehensive diagnostic approaches, including cerebrospinal fluid analysis, GeneXpert MTB/RIF®, and neuroimaging, to correctly diagnose and manage this life-threatening condition. Through these case reports, the article aims to contribute to the medical literature, highlighting the importance of early clinical suspicion and adapted diagnostic strategies in the management of neurotuberculosis in populations of atypical patients.