Clinical case of rifampicin-resistant tuberculous meningitis in a child: features of diagnosis, management and outcomes

Abstract

Aim: to demonstrate, based on an original clinical observation, the features of diagnosis, clinical management, and outcomes of rifampicin-resistant tuberculous meningitis in a child.

Materials and methods. A clinical case of rifampicin-resistant tuberculous meningitis in a child treated in the Pediatric Unit at the clinical base of the Department of Phthisiology and Pulmonology of Zaporizhzhia State Medical and Pharmaceutical University, located at the Public Non-Profit Enterprise “Zaporizhzhia Regional Clinical and Diagnostic Center of Phthisiology and Pulmonology” of the Zaporizhzhia Regional Council.

Results. A child was admitted to the Pediatric Unit from the pediatric intensive care unit (ICU) with a diagnosis of acute tuberculous meningitis. The diagnosis was confirmed by cerebrospinal fluid analysis using the Xpert MTB/RIF Ultra assay, which detected Mycobacterium tuberculosis resistant to the first-line antituberculous medication rifampicin. At the time of transfer, chest radiography revealed no pulmonary abnormalities. Brain magnetic resonance imaging showed no focal pathology. During further evaluation, the child’s mother was diagnosed with chemoresistant tuberculosis. The child received antituberculous and symptomatic therapy prescribed by a neurologist in the ICU for more than four months. During follow-up, chest computed tomography revealed disseminated pulmonary involvement. Following completion of treatment, the child was cured; however, epileptic syndrome developed, requiring lifelong therapy.

Conclusions. Delayed diagnosis of tuberculous meningitis in children is a major risk factor for disability. The clinical presentation is nonspecific, with manifestations typically occurring at later stages of the disease. Management requires combined antituberculous, hormonal, and symptomatic therapy and close cooperation among physicians of various specialties. Rapid and timely diagnosis, screening of at-risk groups, and effective treatment significantly improve prognosis and reduce mortality and disability.