Gigi, R.M.S.Rieder, H.L.Padayatchi, N.2024-05-012024-05-012020-08-31Gigi RMS, Rieder HL, Padayatchi N. When to start treatment? Dilemma illustrated by a paediatric case of extensively drug-resistant tuberculosis of the central nervous system. South African Medical Journal 2020;110(9):846-849. doi:10.7196/SAMJ.2020.v110i9.1456710.7196/SAMJ.2020.v110i9.14567http://www.samj.org.za/index.php/samj/article/view/13066https://hdl.handle.net/11288/595908An HIV-positive mother infected her daughter with extensively drug-resistant Mycobacterium tuberculosis. Despite adhering to the then current guidelines for prevention, the infant was diagnosed with extensively drug-resistant pulmonary tuberculosis at the age of 4 months and developed tuberculous meningitis. After a short delay, appropriate treatment was initiated, followed by an inhospital stay at a specialised hospital. The infant became generally well, but had delayed neurological development. Secondary hydrocephalus due to tuberculous meningitis required a ventriculoperitoneal shunt. After 2 years of microbiologically and clinically effective tuberculosis treatment and several shunt complications, the HIV-negative child died at the age of 28 months ‒ with radiological signs of a shunt infection. The reason for the fatal outcome was probably related to inadequate risk reduction of airborne mother-to-child transmission, inappropriate chemoprophylaxis and delayed initiation of adequate treatment.enAttribution 3.0 United Stateshttp://creativecommons.org/licenses/by/3.0/us/Paediatric tuberculosisCentral nervous systemMeningealExtensive drug resistanceSouth AfricaArticleSouth African Medical Journal