title: [Cerebral tuberculosis in a patient with Sharp's syndrome].
abstract: BACKGROUND
  A 57-year-old female patient with fever and impaired consciousness was admitted to the department of neurology after her first epileptic seizure. She had a 9-year history of mixed connective tissue disease (MCTD, Sharp's syndrome) predominantly presenting with pulmonary symptoms and destructive arthritis. Endoprothetic surgery had to be performed several times and she was given long-term immunosuppressive therapy.
  
  
  METHODS
  Cerebrospinal fluid analysis showed pleocytosis (59/mm3), high protein concentration (2540 mg/l) and low glucose level (31 mg/dl) compared to blood glucose level (122 mg/dl) the indicating possible tuberculous meningoencephalitis.
  
  
  METHODS
  Tuberculostatic therapy was initiated, but despite extensive testing Mycobacterium tuberculosis could initially not be detected by microscopy, culture or amplification techniques (TMA; transcription mediated amplification). Clinical response to antituberculous therapy was poor and the patient developed cerebral ischaemia and hydrocephalus. Because of earlier histological findings from the synovialectomy showing epitheloid cell granuloma a knee joint specimen from a wound drainage was tested and extracerebral tuberculosis was finally confirmed by mycobacterial culture so that tuberculosis as the reason for the meningoencephalitis became highly probable. Despite slight improvements the patient still had hemiparesis and lethargy as neurological sequalae at the end of therapy.
  
  
  CONCLUSIONS
  The case demonstrates the difficulties in the diagnosis of tuberculosis in patients with signs and symptoms similar for those caused by other multisystemic diseases. When tuberculous meningitis is considered, therapy should be initiated even in cases with negative microbiological tests because of severe consequences when treatment is delayed.
authors.affiliation: Neurologische Klinik mit Poliklinik, Universität Erlangen-Nürnberg.
authors.forename: C
authors.initials: C
authors.lastname: Gaul
authors.forename: A
authors.initials: A
authors.lastname: Schmid
authors.forename: W
authors.initials: W
authors.lastname: Mohr
authors.forename: M
authors.initials: M
authors.lastname: Lohoff
authors.forename: J G
authors.initials: JG
authors.lastname: Heckmann
authors.forename: F
authors.initials: F
authors.lastname: Erbguth
authors.forename: B
authors.initials: B
authors.lastname: Neundörfer
mesh_terms: D002545:Brain Ischemia / Q000209:etiology; D002555:Cerebrospinal Fluid / Q000737:chemistry / Q000166:cytology; D003937:Diagnosis, Differential; D004562:Electrocardiography; D004569:Electroencephalography; D004827:Epilepsy / Q000209:etiology; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007719:Knee Joint / Q000382:microbiology; D008875:Middle Aged; D008947:Mixed Connective Tissue Disease / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D013902:Radiography, Thoracic; D013582:Synovial Fluid / Q000382:microbiology; D014057:Tomography, X-Ray Computed; D020306:Tuberculosis, Central Nervous System / Q000150:complications / Q000175:diagnosis* / Q000473:pathology
chemical_list: D007166:Immunosuppressive Agents