An Unusual Presentation of Tuberculous Meningitis

Introduction: Tuberculosis (TB) is one of the most lethal infectious diseases, responsible for high levels of mortality and morbidity. Tuberculous meningitis (TBM) is one of the most severe presentations of extra-pulmonary tuberculosis. Due to its nonspecific signs and symptoms, diagnosis delay and neurological sequelae are common. Thus, it is important to report rare TBM manifestations. Case Presentation: A 66-year-old diabetic man was admitted to our hospital. He complained of prolonged left otalgia and headache. Antibiotic therapy was started for mastoiditis and otitis media. Since his pain did not subside, glucocorticoid therapy was later prescribed to treat suspected temporal arteritis. However, the patient did not respond to treatment. Additional investigations such as imaging and laboratory data were performed, and the patient was finally diagnosed with TBM. The patient subsequently underwent anti-TB treatment. Conclusions: Clinicians should be aware that TBM might have unusual presentations. Early diagnosis and treatment are essential to decrease mortality and morbidity such as irreversible neurological deficits.