A 27-year-old woman with a history of IVF-ET 7 months ago was treated with glucocorticoid, namely, 10 mg of prednisone per day for 30 consecutive days before implantation, and spontaneous abortion occurred after 4 months of pregnancy. She was previously healthy and denied any previous history of TB and close family contacts. Several days later, symptoms such as headache, vomiting, and intermittent low-grade fever developed, and she received several symptomatic treatments in the first month without any effect. Therefore, she was admitted to the neurology department at the local hospital. Figures 1A,B show multiple lesions on her brain's magnetic resonance imaging (MRI). Chest radiography was normal, and the results of a human immunodeficiency virus (HIV) test was negative. In the absence of definite etiological evidence, empirical anti-TB drugs, including isoniazid, rifampin, ethambutol, and pyrazinamide, as well as some symptomatic treatments, were given. The patient was later transferred to the First Affiliated Hospital of Zhengzhou University after her condition worsened with paroxysmal coma and seizures. The signs of meningeal irritation were positive. Lumbar puncture showed the intracranial pressure exceeding 400 mmH2O. CSF examination revealed low glucose (30-40 mg/dl), low chloride (119 mmol/L), WBC of 290*10 9/L (65% lymphocytes and 27% neutrophils), and extremely high level of protein (297.5 mg/dl). Additionally, purified protein derivative (PPD)-positive cells accounted for 24% (reference value: <13.5%) and early secretory antigenic target (ESAT)-6 positive cells represented 23% (reference value: <9.5%) in the CSF. No mycobacteria were found in the CSF by stained smear and culture. Electroencephalogram (EEG) displayed paroxysmal spikes or sharp slow waves. No loss of consciousness with seizures occurred under the continuous administration of the previous anti-tuberculous therapy (ATT) combined with levofloxacin, prednisone, and partial symptomatic treatment, but her headache and intermittent fever were not relieved. Worse still, the patient developed herniation at the end of the first week of treatment, and she received continuous lumbar cerebrospinal fluid (CSF) drainage for one week. Based on routine treatment, intrathecal injections of isoniazid, dexamethasone, and chymotrypsin were performed every two days after removing the drainage tube. After another two months of treatment, the symptoms of fever, headache, and epilepsy were significantly relieved. The improvement of brain MRI is shown in Figure 1C. Her intracranial pressure decreased to 190 mmH20. CSF examination showed reduced WBC of 30*10 9/L (79% lymphocytes), significantly decreased protein (99.5 mg/dl), and normal glucose and chloride.