Meningitis secondary to tuberculosis is considered as a severe form of infection from its spectrum.  The initial clinical manifestation of TB meningitis may mimic healthy pregnancy, and majorities presented with pyrexia of unknown origin required a diversity of investigation before diagnosis often made leading to delay in diagnosis and resulting with a poor outcome. We are presenting a 30 years old lady currently on her second pregnancy admitted to our center for pyrexia of unknown origin for two weeks. Initial work out were inconclusive including malaria, melioidosis and dengue. She had leaking liquor two days of admission and end up with emergency caesarean section due to chorioamnionitis at 32 weeks of gestation under general anesthesia uneventful intraoperatively. Her Glasgow Coma Scale (GCS) dropped (E4V2M2) after 6 hours post-operatively and required intubation for airway protection. CT Brain was done and revealed mild cerebral edema with non-communicating hydrocephalus and neurosurgical input was obtained. She required external ventricular drain (EDV) to release the obstruction and cerebral fluid culture revealed tuberculosis (TB) infection. She was started with anti-TB, however, the condition deteriorating with inadequate treatment response. She succumbed four weeks later due to TB sepsis.  In general obstructive hydrocephalus and neurological deterioration will require a ventricular drain or ventriculoatrial shunt like this case. The Late stage of disease in pregnancy and delay in initiation of treatment are poor prognostic markers. Tuberculosis meningitis is a serious but treatable disorder. Early diagnosis requires a high index of suspicion, especially in pregnant patients can allow us to start the empirical treatment first while investigating other causes as it shown a promising outcome in the previous case report. CSF cytology and biochemical analysis is the main clue to the diagnosis. Clinical outcome depends greatly on the stage of disease at which therapy is initiated. Timely and appropriate initiation of treatment may have a favorable outcome, as we could not achieve in our case due to delay in diagnosis.

Keywords: Tuberculosis, meningitis, pregnancy, hydrocephalus