A 59-year-old woman with tuberculous meningitis masked by hepatic encephalopathy

Tuberculous meningitis is a difficult diagnosis to make. The presenting symptoms, signs, and laboratory values are often nonspecific and can be attributed to other underlying conditions. Imaging and cerebrospinal fluid analysis can be more helpful. Extra pulmonary tuberculosis is not uncommon, and tuberculous meningitis represents 5% of extrapulmonary cases in the United States with the risk for tuberculosis increased six times for foreign-born persons. We report the case of a foreign-born cirrhotic patient with tuberculous meningitis whose diagnosis was likely delayed because of signs and symptoms of her underlying hepatic disease.