Abstract
Tuberculous meningitis (TB meningitis) is a subacute meningitis known for its various form of initial manifestations, which often make early diagnosis difficult. Psychosis is a rare manifestation of this disease. We reported a case of 19-year-old woman who presented with worsening psychotic disorder of one year duration. She presented initially with social isolation with subsequent mutism and stupor. Initial brain imaging & Electroencephalography (EEG) was unremarkable. Cerebrospinal fluid (CSF) investigations revealed positive cerebrospinal fluid Mycobacterium tuberculosis polymerase chain reaction (MTB PCR). She was treated with empirical antituberculosis drugs and steroids. Subsequently her psychotic symptoms resolved. As a conclusions, the psychotic disorder was most likely caused by TB meningitis. TB meningitis should be considered in patients with no background history of psychiatric illness presenting with psychotic disorder especially in countries with high TB burden.
Highlights
Psychosis refers to an abnormal condition of the mind described as involving a loss of contact of reality
Individuals with increased risk for TB meningitis include young children with primary TB and patients with immunodeficiency caused by aging, malnutrition or disorders such as HIV or cancer Eighty percent of TB meningitis patients have foreign travel or other exposure to TB
Many reported cases of TB meningitis are notable for immune-compromise
Summary
Psychosis refers to an abnormal condition of the mind described as involving a loss of contact of reality. It is crucial to diagnose TB meningitis and administer anti-tuberculosis drugs early in the course of the disease This case report presents a rare initial manifestation of TB meningitis. The symptoms had worsens two months prior to admission She complained of constant lethargy which lead her quitting her job as a factory worker. Her family members denied patient’s involvement with high risk behaviors She has no previous contact with tuberculosis patients. The patient showed gradual improvement in ward with increasing alertness and able to interact with family members and medical staffs. She developed delirium later on, manifested by talking to herself, smiling and laughing inappropriately. She could not even recall her admission the hospital (Table 1)
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