Tuberculous Pachymeningitis in a Young Child With Spinal Involvement: A Case Report

Pachymeningitis is a rare chronic disorder of the duramater caused by various infectious, autoimmune or malignant diseases. We report a child with chronic tuberculous pachymeningitis, who presented with clinical manifestations of meningitis with a compatible cerebrospinal fluid analysis. Despite signs of progressive neurological involvement, extensive work-up done to rule out known causes of dural inflammation was negative. The patient was started empirically on anti-tuberculous therapy, to which he responded after 2 weeks. He was discharged on anti-TB medications. He remains well on follow-up. We recommend a trial of anti-tuberculous treatment in children presenting with signs of pachymeningitis in whom the cause of chronic meningeal inflammation cannot be identified.