A rare co-occurrence of optochiasmatic tuberculoma and guillain-barre syndrome as a paradoxical reaction in tubercular meningitis.

Tuberculosis (TB) is the leading infectious cause of death worldwide. Tubercular meningitis is the most severe form of extrapulmonary TB which carries high morbidity and mortality. Intracranial tuberculoma may develop paradoxically during the treatment of tubercular meningitis, which is a quite rare occurrence. There are many reported cases of paradoxical development of optochiasmatic tuberculoma during the treatment of tubercular meningitis, causing severe visual impairment. Association of Guillain-Barré syndrome with TB is a rare entity. However, the co-occurrence of optochiasmatic tuberculoma and Guillain-Barré syndrome is even rarer and not reported before in literature. Here, we present the first case of co-occurrence of optochiasmatic tuberculoma and Guillain-Barré Syndrome, developing as a paradoxical reaction in a 23-year-old male.

Tuberculous encephalopathy without meningitis: A rare manifestation of disseminated tuberculosis.

Tuberculous (TB) encephalopathy is a rare presentation of the central nervous system tuberculosis. Its pathophysiology is believed to have an immune mechanism without any direct invasion by the tubercular bacilli. The clinical presentation is highly variable from mild illness to a potentially fatal one. The characteristic signs of meningitis and cerebrospinal fluid findings are mild or absent. Diffuse white matter edema and demyelination have been noted. This clinical entity has been reported mainly from the pediatric population. In the adult population, it has been reported only in very few case reports. We report here a rare case of TB encephalopathy in a 21-year-old female with disseminated tuberculosis, without meningitis, responding to antitubercular therapy.