Supplementary Material for: Tuberculous Meningitis Presenting with Bilateral Optic Neuritis: A Case Report and Review of Literature

Introduction: Tuberculosis (TB) is a major global cause of morbidity and mortality. Tuberculous meningitis (TBM) is an implication of systemic dissemination of a primary TB infection that indicates a poorer disease prognosis with various long term neurological sequalae. Consequently, it is crucial to understand different clinical presentations and manifestations of such condition. In TBM, vision loss, which is one of the most devastating complications, may result from optic nerve inflammation and atrophy. Although unilateral optic neuritis as a primary presenting symptom of TBM has been broadly reported in the literature, there is paucity of information related to several other rare neuro-ophthalmic features, such as bilateral optic nerve involvement in TBM.
Case presentation: We herein present a case of a 37 years-old Indian male patient presenting with unilateral vision loss that subsequently progressed to bilateral vision loss and was hence diagnosed with bilateral optic neuritis. Additional thorough investigation yielded a diagnosis of TBM with underlying tuberculomas. The patient’s condition improved afterwards with anti-tuberculous therapy and steroids with a follow up magnetic resonance imaging indicating radiological resolution as well.
Conclusion: The differential diagnosis of bilateral optic neuritis is broad but a rare, yet an overlooked one would be central nervous system TB in form of meningitis or tuberculoma. Hence, it is important to identify bilateral optic neuritis as a possible rare presenting symptom of an underlying central nervous system TB infection which could lead to a faster disease diagnosis and treatment to prevent its devastating complications.

Introduction: 结核病（TB）是全球范围内引发发病与死亡的主要病因之一。结核性脑膜炎（TBM）是原发性结核感染全身播散的一类表现，提示患者疾病预后较差，且常伴随多种长期神经后遗症。因此，明确该病症的各类临床表现具有重要临床意义。在结核性脑膜炎患者中，视力丧失属于最具破坏性的并发症之一，其发病机制与视神经炎症及萎缩密切相关。尽管单侧视神经炎作为结核性脑膜炎的首发表现已在文献中被广泛报道，但针对其他罕见神经眼科特征的相关研究资料仍较为匮乏，例如结核性脑膜炎合并双侧视神经受累的情况。
Case presentation: 本研究报告一例37岁印度男性患者，初始表现为单侧视力丧失，后续进展为双侧视力丧失，最终被确诊为双侧视神经炎。经全面深入的检查后，该患者被诊断为合并结核瘤的结核性脑膜炎。患者接受抗结核治疗与类固醇药物治疗后病情好转，后续的磁共振成像（MRI）复查结果显示影像学病灶已实现消退。
Conclusion: 双侧视神经炎的鉴别诊断范围较广，但以脑膜炎或结核瘤形式出现的中枢神经系统结核，是一种易被忽视的罕见鉴别方向。因此，将双侧视神经炎识别为潜在中枢神经系统结核感染的罕见首发表现之一具有重要意义，此举可加快疾病的诊断与治疗进程，从而预防其破坏性并发症的发生。