title: Tuberculous Meningitis in an Immunocompetent Host: A Case Report.
abstract: BACKGROUND Tuberculous meningitis is very rare in the United States in immunocompetent hosts. Risk factors are similar to those of pulmonary tuberculosis, including poverty, malnutrition, overcrowding, a compromised immune system, and coming from an endemic area. Meningeal tuberculosis mortality and other outcomes have changed little over time despite effective therapies due to delay in diagnosis because of its rarity, variable presentation, and often indolent course. CASE REPORT We describe a case of a 57-year-old male immigrant from Senegal with no significant past medical history and no previous history of tuberculosis or evidence of immune compromise. He presented to the hospital with headache and altered mental status and was subsequently diagnosed with tuberculous meningitis. CONCLUSIONS This is a rare case of tuberculous meningitis in an immunocompetent host, questioning the conventional view that tuberculous meningitis is a disease of immunocompromised individuals. It emphasizes the importance of maintaining a strong clinical suspicion of tuberculous meningitis even in an immunocompetent patient in a geographical area with low prevalence if the patient has risk factors. Missed or delayed diagnosis is commonly fatal.
authors.affiliation: Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA.
authors.forename: Suchin R
authors.initials: SR
authors.lastname: Khanna
authors.affiliation: Department of Infectious Diseases, University of Cincinnati Medical Center, Medical Epidemiologist, National Infectious Diseases Program, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH, USA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Kralovic
authors.affiliation: Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA.
authors.forename: Rajan
authors.initials: R
authors.lastname: Prakash
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D002555:Cerebrospinal Fluid / Q000276:immunology; D004359:Drug Therapy, Combination; D054242:Emigrants and Immigrants; D006801:Humans; D007121:Immunocompetence; D007538:Isoniazid / Q000627:therapeutic use; D064704:Levofloxacin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000276:immunology*; D011718:Pyrazinamide / Q000627:therapeutic use; D012293:Rifampin / Q000627:therapeutic use; D012675:Senegal; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D014481:United States
chemical_list: D000995:Antitubercular Agents; D011718:Pyrazinamide; D064704:Levofloxacin; D007538:Isoniazid; D012293:Rifampin