TY - JOUR
T1 - Diagnostic Challenges and Dilemmas in Tuberculous Meningitis
AU - Chesdachai, Supavit
AU - Katz, Benjamin
AU - Sapkota, Smarika
N1 - Publisher Copyright:
© 2020 Southern Society for Clinical Investigation
PY - 2020/6
Y1 - 2020/6
N2 - Tuberculosis is a global burden with an unacceptably high mortality rate, especially in low- and middle-income countries. We reported the case of 34-year-old Somali female with no significant risk factors who initially presented with headache and blurred vision. The patient subsequently developed altered mental status and significant vision changes. Initial lumbar puncture showed lymphocytic pleocytosis with negative gram stain, acid-fast bacilli stain, and culture. Initial polymerase chain reaction for tuberculosis was negative. The patient worsened despite receiving broad-spectrum antibiotics. The patient had a prolonged hospital course and eventually required lumbar drain placement for hydrocephalus. Repeated polymerase chain reactions for Mycobacterium tuberculosis from the lumbar drain samples was positive, and the diagnosis of tuberculous meningitis was confirmed. The patient improved after lumbar drain placement and treatment with isoniazid, rifampin, pyrazinamide, ethambutol and steroid tapering. This case illustrated the challenge of diagnosing tuberculous meningitis.
AB - Tuberculosis is a global burden with an unacceptably high mortality rate, especially in low- and middle-income countries. We reported the case of 34-year-old Somali female with no significant risk factors who initially presented with headache and blurred vision. The patient subsequently developed altered mental status and significant vision changes. Initial lumbar puncture showed lymphocytic pleocytosis with negative gram stain, acid-fast bacilli stain, and culture. Initial polymerase chain reaction for tuberculosis was negative. The patient worsened despite receiving broad-spectrum antibiotics. The patient had a prolonged hospital course and eventually required lumbar drain placement for hydrocephalus. Repeated polymerase chain reactions for Mycobacterium tuberculosis from the lumbar drain samples was positive, and the diagnosis of tuberculous meningitis was confirmed. The patient improved after lumbar drain placement and treatment with isoniazid, rifampin, pyrazinamide, ethambutol and steroid tapering. This case illustrated the challenge of diagnosing tuberculous meningitis.
KW - Tuberculosis, Mycobacterium tuberculosis
KW - Tuberculous meningitis
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U2 - 10.1016/j.amjms.2020.03.010
DO - 10.1016/j.amjms.2020.03.010
M3 - Review article
C2 - 32317167
AN - SCOPUS:85083328309
SN - 0002-9629
VL - 359
SP - 372
EP - 377
JO - American Journal of the Medical Sciences
JF - American Journal of the Medical Sciences
IS - 6
ER -