title: Atypical presentations of tuberculous meningitis--a case report.
abstract: A case of tuberculous meningitis, proved by cerebrospinal fluid (CSF) cultures, is reported due to atypical findings in CSF. This 19-year-old man developed subacute headache and fever for 2 weeks, followed by focal seizure and left hemiparesis. Initial CSF study showed hemorrhagic lymphocytic pleocytosis with mildly elevated protein and normal sugar content, mimicking viral or postinfectious meningoencephalitis. Follow-up CSF studies showed polymorphonuclear pleocytosis. A concomitant bacterial meningoencephalitis was suspected, though repeated CSF cultures did not isolate any bacteria. The activity of adenosine deaminase in CSF was 12 U/L, highly suggestive of tuberculous meningitis. Magnetic resonance imaging (MRI) showed only a focal meningoencephalitis in the right lateral frontal cortex. Due to progressive deterioration of the clinical status, umbrella therapy, including antimycobacterial drugs and strong antibiotics were given. At a later time, growth of tubercle bacilli was reported in the CSF cultures. Follow-up study of MRI 4 months later, showed thick abnormal enhancement in the basal cisterns and obstructive hydrocephalus, typical findings of chronic basal meningitis.
authors.affiliation: Department of Internal Medicine, Veterans General Hospital-Taichung, Taiwan, R.O.C.
authors.forename: P Y
authors.initials: PY
authors.lastname: Wang
authors.forename: F Y
authors.initials: FY
authors.lastname: Hsieh
authors.forename: T Y
authors.initials: TY
authors.lastname: Cheng
mesh_terms: D000243:Adenosine Deaminase / Q000134:cerebrospinal fluid; D000328:Adult; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D014390:Tuberculosis, Meningeal / Q000175:diagnosis*
chemical_list: D000243:Adenosine Deaminase