Sepsis-Like Presentation of Tuberculous Meningitis With Rapid Neurologic Decline and Spinal Subdural Abscesses: A Case Report.

Tuberculous meningitis (TBM) is the most severe form of central nervous system tuberculosis and carries high morbidity and mortality. We report a 35-year-old man from Ecuador who presented with sepsis-like systemic symptoms and rapidly progressive neurological deficits. Initial imaging revealed cavitary pulmonary lesions and hilar lymphadenopathy, suggestive of pulmonary tuberculosis. Neurological deterioration prompted magnetic resonance imaging (MRI) of the brain and cervical spine, demonstrating communicating hydrocephalus, basilar leptomeningeal enhancement, diffuse cervical cord edema, and multiple rim-enhancing subdural abscesses. Diagnosis was confirmed via bronchoalveolar lavage positive for Mycobacterium tuberculosis after multiple failed sputum induction attempts. This case illustrates a combination of sepsis-like presentation, rapid quadriparesis, and spinal cord abscesses in TBM, highlighting the importance of advanced imaging and alternative microbiologic sampling for timely diagnosis and management.