CNS Tuberculosis and Peripheral Medium Vessel Vasculitis: A Rare Presentation of Mycobacterium Tuberculosis Infection

Abstract

Background: Tuberculosis is a very common disease in India with varied presentations. CNS Tuberculosis (TB) is the most severe form of TB in children and leads to mortality, if not treated timely and effectively (1).Case report: A 7-year-old boy born out of a non-consanguineous marriage was admitted with a history of acute onset of extreme irritability, agitation and inability to recognize parents. Our patient presented with CNS TB and peripheral gangrene for which no cause could be ascertained clinically. We considered that the gangrene resulted from vasculitis secondary to tuberculosis infection based on the pathological presentation, radiographic changes and therapeutic response to ATT. The patient was treated with Antitubercular therapy (Isoniazid, Rifampicin, Pyrazinamide and Ethambutol) for 6 months, oral Prednisolone @ 2 mg/kg/day for 4 weeks with subsequent tapering to 1mg/kg/day for another 4 weeks and oral Aspirin @ 3 mg/kg/day for 6 months. He showed significant improvements with the above said management, with pain significantly decreased and range of motion improved after 2 weeks of starting treatment. He was discharged after 2 weeks. The child was followed up over a period of 2 years and there had been no reappearance of the above mentioned symptoms.Conclusion: Overall, in this case, it was presumed that Mycobacterium tuberculosis infection was responsible for the neurological manifestations (CNS Tuberculosis) and it also induced the vasculitis process, ultimately causing gangrene and diminished pulsations of extremities.