结核性脑膜炎(tuberculous meningitis，TBM)是中枢神经系统结核病最常见和最严重的一种类型，其与高死亡率和发病率相关，但难以诊断和治疗，严重威胁人类健康。临床上常因TBM症状不典型、缺乏早期快速敏感而特异的诊断检测技术、合并其他病原菌感染而误诊、耐多药结核病、抗结核药物受血脑屏障限制等因素而导致疾病的高病死率和高致残率。本文总结一例因新型冠状病毒肺炎筛查而确诊的结核性脑膜炎病例，患者因昏迷就医后送检脑脊液涂片等完善相关实验室检查，脑脊液抗酸染色检测阳性提示临床快速诊断TBM。虽然TBM分子诊断技术具有较高的灵敏性、特异性，但传统的脑脊液抗酸涂片检测具有简单、快速、低成本的优势，可为资源有限地区提供快速诊断依据。临床实践中应联合应用涂片镜检、分子检测及培养技术，构建TBM阶梯式诊断体系。

Tuberculous meningitis (TBM) is the most common and severe form of central nervous system tuberculosis, characterized by high mortality and morbidity rates. However, its diagnosis and treatment remain challenging, posing a significant threat to global health. Clinically, the high fatality and disability rates associated with TBM are attributed to multiple factors, including nonspecific clinical manifestations, lack of rapid and sensitive diagnostic tests for early detection, frequent misdiagnosis due to coinfection with other pathogens, the emergence of multidrug-resistant tuberculosis (MDR-TB), and limited blood-brain barrier penetration of antitubercular drugs. This article summarized a case of TBM incidentally diagnosed during COVID-19 screening. A patient presenting with coma underwent cerebrospinal fluid (CSF) smear examination and related laboratory tests. A positive result of acid-fast staining of CSF prompted a rapid clinical diagnosis of TBM. Although molecular diagnostic techniques for TBM demonstrate superior sensitivity and specificity, traditional CSF acid-fast smear microscopy retains unique advantages, such as simplicity, rapid turnaround time and low cost, making it a critical diagnostic tool in resource-limited settings. This study recommends integrating smear microscopy, molecular testing, and culture techniques in clinical practice to establish a stepwise diagnostic framework for TBM.