title: Psychosis secondary to tuberculosis meningitis.
abstract: We report a case of a 19-year-old immunocompetent Malay woman who presented with a worsening psychotic disorder of 1-year duration. She initially presented with social isolation with subsequent mutism and stupor. Physical examination revealed a stuporous, emaciated, dehydrated woman with Glasgow Coma Scale of 11/15 (E4V2M5). She had a blank stare, mutism and akinesia. Motor examination revealed upper motor neuron findings. Neck stiffness was present, however, Kernig's and Brudzinski's signs were negative. There were no other findings on other systems. Brain imaging and EEG were normal. Cerebrospinal fluid investigations revealed positive cerebrospinal fluid Mycobacterium tuberculosis PCR (MTB PCR). The patient was treated with empirical antituberculosis drugs and steroids. On follow-up visit 1 month later, her psychotic symptoms had fully resolved. She was able to ambulate and care for herself; she was unable to recall the symptoms she had experienced before and during admission.
authors.affiliation: Department of Internal Medicine, Hospital Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.
authors.forename: Mohd Jazman Che
authors.initials: MJ
authors.lastname: Rahim
authors.affiliation: Department of Internal Medicine, Hospital Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.
authors.forename: Wan Syamimee Wan
authors.initials: WS
authors.lastname: Ghazali
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D011618:Psychotic Disorders / Q000209:etiology*; D012021:Reflex, Abnormal; D013256:Steroids / Q000627:therapeutic use; D014390:Tuberculosis, Meningeal / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D013256:Steroids