Immune Reconstitution Inflammatory Syndrome In a Child with Tuberculous Meningitis

Case Report A 2-year-old previously healthy, HIV negative, female was recently diagnosed with TB meningitis and treated with directly-observed, four-drug anti-tuberculous therapy (rifampin, isoniazid, pyrazinamide, ethambutol) and dexamethasone taper. Her initial diagnosis was made via history, imaging, and positive interferon-gamma release assay (IGRA); after discharge, her cerebrospinal fluid culture grew a single colony of pan-sensitive Mycobacterium tuberculosis. Six weeks after discharge from this initial hospitalization, she presented with seizures, emesis, and altered mental status. She was unable to follow commands, had intermittent facial droop, and was irritable. MRI showed non-communicating hydrocephalus, leptomeningeal enhancement, and possible basilar …