title: Tuberculous meningitis masked by delirium in an alcohol-dependent patient: a case report.
abstract: OBJECTIVE
  Patients with alcohol dependence syndrome can present with delirium which will mask underlying organic causes for the delirium. However, other medical diseases can also present with similar symptoms and should not be missed. The issues related to differentiating the different causes of delirium are briefly discussed. We describe a case of tuberculous meningitis in a patient with history of alcohol dependence who presented with delirium.
  
  
  METHODS
  A case report.
  
  
  RESULTS
  A 38-year-old male was admitted with history of irrelevant talk and abnormal behaviour of 2-month duration. He was also disoriented and his short-term memory was impaired. He reported visual hallucinations. He had history of alcohol dependence of 5 years. A detailed mental status examination and neurological workup revealed an organic psychosis. CT scan showed a hypodense lesion suggestive of a tuberculoma. The cerebrospinal fluid findings were corroborative. He responded to antituberculous drugs which he took for one and a half years and recovered completely. He also underwent group therapy for his alcohol dependence and has since then refrained from alcohol intake. Currently he has gone back to his work as a car mechanic.
  
  
  CONCLUSIONS
  We have highlighted the need for diagnosing and investigating carefully the cause of delirium in a patient with alcohol dependence syndrome. This shows that other curable causes of delirium must also be investigated in patients with alcohol dependence.
authors.affiliation: Department of Psychiatry, Christian Medical College, Vellore, TN, India. pjebaraj@hotmail.com
authors.forename: P
authors.initials: P
authors.lastname: Jebaraj
authors.forename: M
authors.initials: M
authors.lastname: Oommen
authors.forename: P
authors.initials: P
authors.lastname: Thopuram
authors.forename: K S
authors.initials: KS
authors.lastname: Jacob
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications*; D003693:Delirium / Q000209:etiology*; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D014057:Tomography, X-Ray Computed; D014390:Tuberculosis, Meningeal / Q000150:complications*