Late Presentation of Multidrug-Resistant Pulmonary Tuberculosis 27 Years after Treated Intracranial Tuberculoma: A Case Report

Abstract

Introduction

Reactivation of tuberculosis after decades of apparent cure is not unheard of, but multidrug-resistant disease appearing this late — particularly after a central nervous system infection — is rarely documented.

Case Presentation

We describe a 58-year-old woman who developed fever, weight loss, and a persistent cough twenty-seven years after successful treatment of an intracranial tuberculoma. A cavitary lesion in the right upper lobe led to a diagnosis of multidrug-resistant tuberculosis, with resistance to both rifampicin and isoniazid confirmed on molecular and phenotypic testing. She began a bedaquiline-based regimen in line with current WHO guidance and went on to achieve early culture conversion along with steady clinical and radiological recovery.

Conclusions

This case is a reminder of how unpredictable tuberculosis latency can be, reinforces the diagnostic value of molecular testing, and confirms the effectiveness of contemporary MDR-TB regimens — while making clear that clinical vigilance should not lapse even decades after apparent cure.