title: [An adult case of tuberculous meningitis].
abstract: A 36-year-old man was referred to our hospital with complaints of high fever and headache. A diagnosis of miliary tuberculosis with tuberculous meningitis was made. He was treated with isoniazid (400 mg/day), rifampicin (300 mg/day), ethambutol (750 mg/day), pyrazinamide (1.0 g/day) and prednisolone (60 mg/day). However, he lost consciousness because of hydrocephalus on the second day of hospitalization. Emergency cerebrospinal fluid drainage improved his neurological symptoms. After two months, he again complained of headache with nausea and double vision. Numerous tuberculomas were found not only in the cerebrum but also in the liver, the spleen and the retina. Recurrent hydrocephalus was treated with a V-P shunt, and combination therapy with four antituberculous agents was maintained for 18 months. He was discharged in a healthy condition, although a mild left facial palsy remained. In addition, we examined the inflammatory cytokine levels in both the CSF and the serum over the period of the patient's hospitalization. We concluded that the cytokine levels in the CSF may be associated with the progress and the prognosis of tuberculous meningitis.
authors.affiliation: Department of Respiratory Medicine, National Dohoku Hospital, 7, Hanasaki-cho, Asahikawa, Hokkaido, Japan.
authors.forename: Shoko
authors.initials: S
authors.lastname: Nakao
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Satoru
authors.initials: S
authors.lastname: Fujiuchi
authors.forename: Masaaki
authors.initials: M
authors.lastname: Takahashi
authors.forename: Kazue
authors.initials: K
authors.lastname: Sato
authors.forename: Akinori
authors.initials: A
authors.lastname: Takeda
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Okamoto
authors.forename: Yuka
authors.initials: Y
authors.lastname: Fujita
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Yamazaki
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Fujikane
authors.forename: Osamu
authors.initials: O
authors.lastname: Yahara
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Shimizu
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage*; D016207:Cytokines / Q000134:cerebrospinal fluid; D004359:Drug Therapy, Combination; D004977:Ethambutol / Q000008:administration & dosage; D006801:Humans; D007538:Isoniazid / Q000008:administration & dosage; D008297:Male; D011379:Prognosis; D012293:Rifampin / Q000008:administration & dosage; D014390:Tuberculosis, Meningeal / Q000134:cerebrospinal fluid / Q000188:drug therapy*; D014391:Tuberculosis, Miliary / Q000134:cerebrospinal fluid / Q000188:drug therapy*
chemical_list: D000995:Antitubercular Agents; D016207:Cytokines; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin