Tuberculous meningoencephalitis in patient co-infected with herpes simplex virus

Abstract

Objective — to pay attention of clinicians to sterile meningoencephalitis, which in fact can be caused by mycobacteria tuberculosis.Materials and methods. The routine lab methods were used in the study. The bacterial and viral DNA sequences were quantified by real-time PCR. Smear microscopy using the Ziehl-Neelsen stain, and CSF pellet cultivation on the Lowenstein-Jensen medium were used for searching of M. tuberculosis.Results and discussion. A young woman was admitted to our hospital because of fever, headache and hallucinations, and meningeal symptoms. Pleocytosis, decreased level of glucose, HSV-1 DNA and antibodies to the virus were found in CSF sample. Although antibiotics and acyclovir were administered, fever, hallucinations and meningeal signs intensified. A second CSF sample contained higher level of cytosis and a «spider-web» cloth (SWC). So, tuberculosis was regarded as the most likely cause of the disease. Later, when M. tuberculosis DNA was revealed in CSF, the diagnosis was confirmed. The patient started receiving antituberculous treatment with good effect. Conclusions. The possibility of latent involvement in the process of M. tuberculosis should be kept in mind in any cases of sterile meningoencephalitis. An empiric trial of antituberculosis therapy may be useful in other cases of apparently idiopathic meningoencephalitis.