Background: Tuberculous meningoencephalitis is an infrequent disease. The diagnosis given the poor specificity of complementary tests is very difficult, as well as the treatment in patients infected with the human immunodeficiency virus doing antiretrovirals.
Case Summary: We present the case of a 33-year-old man with history of intravenous drug user, hepatitis B and HIV coinfection, lymph node tuberculosis and meningitis due to Cryptococcus Neoformans; was admitted to the Emergency Department due to altered state of consciousness and neurological focality, with a week of evolution. In the diagnostic process, several etiological hypotheses were discarded and several lines of empirical treatment were instituted, until some evidence was obtained. Multiple imaging tests were performed and the progression of the CT scan was the one that ended up confirming the diagnosis.
Conclusion: Despite the great advances in medicine, Tuberculosis seems to be the heel of Achilles, where, having the certainty of the diagnosis remains, as in the case presented, tremendously difficult. We have laboratory, microbiological, imaging and even biopsy exams, and sometimes it is not enough to achieve the diagnosis with evidence. In the case presented, the only evidence was obtained due to the evolution of the lesions, which should never be a limiting factor for the initiation of treatment, due to the serious consequences that the non-implementation of treatment may have.
Key words: Central Nervous System Infections; Meningoencephalitis; Tuberculosis; HIV