Tuberculous Meningitis in a Child: A Rare Presentation of Cytotoxic Lesion of the Corpus Callosum

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Abstract
Tuberculous meningitis (TBM) is the most severe form of tuberculosis, disproportionately affecting vulnerable populations such as young children and people living with human immunodeficiency virus (HIV). Major challenges to accurate and early diagnosis of TBM are the non-specific clinical features which overlap with other infectious syndromes and the lack of adequately sensitive tests to detect Mycobacterium tuberculosis in the cerebrospinal fluid (CSF). Diagnosis is, therefore, still dependent on clinical suspicion along with clinical features, cerebrospinal fluid (CSF) characteristics and, where facilities are available, neuroimaging. Typical neuroimaging features of TBM include hydrocephalus, infarcts, tuberculomas and basal exudates; however, less well described are very rare features such as cytotoxic lesion of the corpus callosum (CLOCC), otherwise known as transient splenic lesion. We describe the first case report of a child with confirmed TBM who had a very rare presentation of CLOCC with complete recovery and present a literature review on the pathophysiology and alternative aetiologies where CLOCC is more commonly seen.

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