The clinical manifestations of tuberculous meningoencephalitis(TBME)are varied,and diagnostic tests for Mycobacterium tuberculosis show limited sensitivity and specificity,often failing to provide timely diagnostic support,which can delay prompt treatment.Reports on anti-neurexin-3α antibody-mediated autoimmune encephalitis remain scarce,and there have been no documented cases of TBME overlapping with anti-neurexin-3α antibody-associated encephalitis either domestically or internationally.This article presents a case treated at our hospital to contribute insights for improving the diagnosis and treatment of such conditions in the future.The patient,a middle-aged woman,presented with a one-month history of headache and incoherent speech,along with one day of left-sided limb weakness.Lumbar puncture results revealed significantly elevated cerebrospinal fluid(CSF)pressure,an increased lymphocyte count,and reduced glucose and chloride levels.Enhanced MRI showed multiple intracranial lesions,basal meningeal enhancement,and marked hydrocephalus,supporting an initial diagnosis of TBME.Concurrently,both blood and CSF tests were positive for anti-neurexin-3α antibodies.After comprehensive treatment,including anti-tuberculosis therapy,high-dose immunoglobulin,and corticosteroids,the patient's clinical symptoms,CSF findings,and MRI results improved,and she was discharged.

The clinical manifestations of tuberculous meningoencephalitis(TBME)are varied,and diagnostic tests for Mycobacterium tuberculosis show limited sensitivity and specificity,often failing to provide timely diagnostic support,which can delay prompt treatment.Reports on anti-neurexin-3α antibody-mediated autoimmune encephalitis remain scarce,and there have been no documented cases of TBME overlapping with anti-neurexin-3α antibody-associated encephalitis either domestically or internationally.This article presents a case treated at our hospital to contribute insights for improving the diagnosis and treatment of such conditions in the future.The patient,a middle-aged woman,presented with a one-month history of headache and incoherent speech,along with one day of left-sided limb weakness.Lumbar puncture results revealed significantly elevated cerebrospinal fluid(CSF)pressure,an increased lymphocyte count,and reduced glucose and chloride levels.Enhanced MRI showed multiple intracranial lesions,basal meningeal enhancement,and marked hydrocephalus,supporting an initial diagnosis of TBME.Concurrently,both blood and CSF tests were positive for anti-neurexin-3α antibodies.After comprehensive treatment,including anti-tuberculosis therapy,high-dose immunoglobulin,and corticosteroids,the patient's clinical symptoms,CSF findings,and MRI results improved,and she was discharged.