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Untung Gunarto
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Medicine & Pharmacology

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Disseminated Tuberculosis with Tuberculous Meningitis And Multisegmental Tuberculous Sponsylitis: A Case Report Fitria Nurlaely; Prasetyo Tri Kuncoro; Fatiha Sri Utami Tamad; Tutik Ermawati; Untung Gunarto; Muhamad Rifqy Setyanto
Medical and Health Journal Vol 6 No 1 (2026): August
Publisher : Fakultas Kedokteran Universitas Jenderal Soedirman

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20884/1.mhj.2026.6.1.20731

Abstract

Background: The combination of tuberculous meningitis and tuberculous spondylitis as a manifestation of disseminated tuberculosis (TB) is a rarely reported condition often associated with poor clinical outcomes due to delayed diagnosis. This case report aims to highlight the importance of maintaining clinical suspicion for disseminated TB in patients presenting with a combination of neurological symptoms and chronic back pain. Case Presentation: A 30 year old woman presented with a 15 month history of progressive chronic low back pain radiating to both legs, which subsequently progressed to headache and altered consciousness. Neurological examination revealed signs of meningeal irritation, paraparesis, and sensory impairment at the T4 level. Imaging studies demonstrated multiple foci of tuberculous spondylitis and meningeal involvement, while cerebrospinal fluid analysis and molecular testing confirmed tuberculous meningitis. Based on the combnation of clinical manifestations, imaging findings, and ancillary tests, the patient was diagnosed with disseminated TB. She received anti-tuberculosis therapy, corticosteroids, and underwent a laminectomy with posterior fusion. Discussion: This case demonstrates that the combination of chronic back pain and progressive neurological symptoms should raise suspicion of disseminated TB, even though these manifestations rarely occur concurrently. Early diagnosis achieved through the integration of clinical, radiological, and microbiological findings enables appropriate multidisciplinary therapy, thereby contributing to improved clinical outcomes. Conclusion: Disseminated tuberculosis should be considered in patients presenting with a combination of neurological symptoms and chronic back pain. Clinical vigilance, early diagnosis, and adequate multidisciplinary management play a crucial role in improving the patient's prognosis and clinical outcomes.
A Rare Case Report of Subdural Empyema as a Severe Intracranial Complication of Maxillary Sinusitis Fetra Bagus Tira; M. Pramudigdo; S. Dirahayu; Untung Gunarto
Medical and Health Journal Vol 6 No 1 (2026): August
Publisher : Fakultas Kedokteran Universitas Jenderal Soedirman

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20884/1.mhj.2026.6.1.21037

Abstract

Subdural empyema is a rare but potentially life-threatening intracranial complication of bacterial sinusitis. This case report described a 34-year-old man who presented with progressive impairment of consciousness following generalized tonic-clonic seizures. The patient had a three-month history of sinusitis and subsequently developed foul-smelling purulent nasal discharge, worsening headache, and high-grade fever. Neurological examination revealed impaired consciousness and nuchal rigidity without focal motor deficits. Laboratory investigations demonstrated leukocytosis, neutrophilia, an elevated neutrophil-to-lymphocyte ratio, reactive thrombocytosis, and mild anemia. Contrast-enhanced head computed tomography revealed a right frontoparietotemporal crescent-shaped subdural collection with peripheral enhancement, cerebral edema, a 0.7-centimeter midline shift, subfalcine herniation, and associated meningoencephalitis. Opacification of multiple paranasal sinuses, including the right maxillary sinus, supported sinusitis as the infectious source. The patient was treated with intravenous broad-spectrum antibiotics, anticonvulsant therapy, corticosteroids, and supportive management. Following multidisciplinary evaluation, conservative treatment was continued without surgical drainage because the patient showed progressive clinical improvement. His consciousness improved, no recurrent seizures occurred, and his headache subsided. The patient was discharged in stable neurological condition. This case highlighted the importance of early recognition, prompt neuroimaging, appropriate antimicrobial therapy, and multidisciplinary management in patients with sinusitis who developed neurological deterioration.
Co-Authors Fatiha Sri Utami Tamad Fetra Bagus Tira Fitria Nurlaely M. Pramudigdo Muhamad Rifqy Setyanto Prasetyo Tri Kuncoro S. Dirahayu Tutik Ermawati