Abstract
Empiric anti-tuberculous therapy should not be delayed in patients with a strong clinical suspicion for TB. Because confirmatory TB testing may be difficult to obtain, early and empiric treatment, when there is concern for central nervous system TB, may result in improved outcomes for patients. GeneXpert is currently an area of active research, and the test returns diagnostic results within hours, which would make it the preferred test for investigating TB meningitis.
Highlights
Central nervous system (CNS) involvement accounts for about 5–10% of extra-pulmonary tuberculosis (TB) and is present in ∼1% of all TB cases [1]
We describe a patient in the US with severe meningitis of initially unclear etiology who, despite negative TB screening tests, was found to have tuberculous meningitis upon autopsy
At 2 days after the autopsy, the original cerebrospinal fluid (CSF) acid-fast bacilli (AFB) culture resulted in the growth of M. tuberculosis complex
Summary
Central nervous system (CNS) involvement accounts for about 5–10% of extra-pulmonary tuberculosis (TB) and is present in ∼1% of all TB cases [1]. A few days afterwards, he started complaining of non-specific upper respiratory symptoms, including cough and sinus congestion, for which he went to an urgent care and received amoxicillin Despite this treatment, his symptoms continued to worsen over 2 weeks, and he became more lethargic, resulting in his initial presentation to the hospital. An MRI of the brain with contrast showed leptomeningeal enhancement as well as a left anterior cerebral artery infarct. His lethargy worsened over 3 days, requiring intubation and transfer to our intensive care unit (ICU). A repeat MRI of the brain on hospital day 5 demonstrated an evidence of basilar meningitis, interval development of hydrocephalus, persistent leptomeningeal enhancement, most prominent in the bilateral frontal lobes, and the previously seen left anterior cerebral artery territory infarct. At 2 days after the autopsy, the original CSF AFB culture resulted in the growth of M. tuberculosis complex
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