Fatal tuberculous brain abscesses in an immunocompetent woman (original) (raw)
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Tuberculous meningitis presenting with unusual clinical features in Nigerians: Two case reports
Cases Journal, 2008
Background: Tuberculous meningitis is common in developing countries and accounts for about 7.8% to 14% of all cases of tuberculosis in Nigeria. Case presentation: Case 1 was a 17-year-old woman who presented with a 3-week history of weakness of the right upper and lower limbs, a 6-hour history of inability to speak and irrational behaviour. She had no remarkable past medical history. Physical examination revealed pyrexia (temperature of 38.2°C) and altered level of consciousness (Glasgow coma score = 7/15). The signs of meningeal irritation were present and she had anisocoria and right spastic hemiparesis. Other aspects of physical examination were normal. Laboratory investigations showed an elevated erythrocyte sedimentation rate, normal cerebrospinal fluid protein and reduced glucose. The brain computed tomography scan showed features in keeping with obstructive hydrocephalus and she was immediately commenced on antituberculous drugs, intravenous steroids and mannitol. She made a remarkable clinical recovery and was discharged home 6 weeks after admission. Case 2 was a 40-year-old man who presented with a 6-week history of headache and fever and a 2-week history of alteration in level of consciousness. There was no history of neck pain and/or stiffness, nausea or vomiting. He had no other remarkable past medical history. He had been placed on various intravenous antibiotics in private hospitals before presentation, with no clinical improvement. Physical examination showed a young man in a coma (Glasgow coma score = 4/15) and febrile (temperature of 38.5°C) with signs of meningeal irritation. The brain stem reflexes were impaired and he had spastic quadriparesis. Further physical examination was essentially normal. The cerebrospinal fluid analysis showed features in keeping with meningeal inflammation and he had a raised erythrocyte sedimentation rate. The brain computed tomography scan showed features in keeping with obstructive hydrocephalus. He was placed on antituberculous drugs and intravenous steroids but despite this his clinical condition deteriorated and he died on the sixth day after admission. Conclusion: Late presentation of tuberculous meningitis is not rare in Nigerians and we report two cases of tuberculous meningitis that presented late to our health care facility. This report is intended to make clinicians aware of the unusual clinical presentations of tuberculous meningitis.
Rare Clinical Presentation of Tuberculous Meningitis: A Case Report
The Malaysian journal of medical sciences : MJMS, 2017
Tuberculosis is the second leading cause of death under the category of infectious diseases, after the human immunodeficiency virus (HIV). Tuberculous meningitis (TBM) constitutes about 5% of all extrapulmonary disease worldwide. This report describes a case of Tuberculous meningitis with rare presentation in a 28-year-old woman, who was treated based on a collection of her social background, clinical findings and Multiplex PCR of tuberculosis. A 28-year-old Malay woman with no significant medical history presented to HUSM with one month history of on and off fever, two weeks history of generalised limbs weakness and one week history of dysphagia. She was reported to have experienced visual hallucination and significant weight loss. Her laboratory result is significant for leukocytosis, elevated ESR and hypernatremia. Non-enhanced and contrast CT scan of the brain showed severe bilateral frontal cerebral atrophy. Cerebral spinal fluid (CSF) for multiplex PCR for complex was positive...
Hydrocephalus Caused by Tuberculous Meningitis in an Immunocompetent Young Adult: A Case Report
International Medical Case Reports Journal
Background: Despite improved medical management, meningeal tuberculosis mortality and other outcomes have changed slightly over time due to a delay in diagnosis and treatment. This study reports a rare case of tuberculous meningitis in an immunocompetent host, calling into question the commonly held belief that tuberculous meningitis is a disease of immunocompromised individuals. Case Presentation: A 26-year-old male with no significant past medical history, tuberculosis, or indications of immunological compromise, was admitted to our hospital with a fever and altered mental status. He was drowsy, febrile (temperature of 38°C), had a heart rate of 110 beats per minute, and showed mild neck stiffness but no meningeal sign. A lumbar puncture on the third day of admission suggested tuberculous meningitis. He was treated for tuberculosis meningitis, and his condition slightly improved. However, the patient's condition suddenly worsened, and a repeat contrast computed tomography (CT) of the brain showed the development of ventriculomegaly and basilar enhancement. Insertion of an emergency ventriculoperitoneal shunt was performed; however, the patient died ten days after hospital admission. Conclusion: We report a fatal case of tuberculous meningitis in an immunocompetent patient. Healthcare practitioners must be trained to identify and diagnose tuberculous meningitis promptly. Early treatment of tuberculous meningitis based on clinical diagnosis and symptoms improves clinical outcomes.
A Case Report on Tuberculous Meningitis
Journal of Pharmaceutical Research International
Introduction: The most common cause of tuberculous meningitis is a hematogenous spread of mycobacteria from the lungs. tuberculous meningitis is a fatal disease. Symptoms typically worsen over time, and there are three clinical stages to the disease (prodromal phase, phase of neurological symptoms and phase of paresis) Case Presentation: The chief complaint of a one-year-old boy was fever, irritability, vomiting, and Generalized Tonic-Clonic Seizure convulsions. The patient's pupils were found to be unequal on physical examination, prompting a repeat neuroimaging. It was done on MRI (magnetic resonance imaging) with T1 hyperintensity on T2 and restricted diffusion on DWI (diffusion-weighted imaging) he has not improved after taking treatment and the patient is on a ventilator as well, we nasogastric tube also. I was receiving treatment and will continue to do so until the end of my care. Conclusion: In our environment, tuberculous meningitis that presents late is not uncommon. ...
Journal of Emergency Medicine and Intensive Care, 2015
Tuberculosis is a chronic necrotizing granulomatous disease caused by Mycobacterium tuberculosis, causes morbidity and mortality worldwide, and affects children as in all age groups. Tuberculous meningitis (TM) is the most severe form of the disease. The pathogenesis of TM is poorly understood and the best management has not been established. We report 17-years old female patient, who was referred from Somalia with a suspected intracranial mass lesion accompanied by poor general condition, reduced consciousness, hypertension and bradycardia, diagnosed as TM after brain biopsy with result of positive PCR and culture for M. tuberculosis. But the patient died after diagnosis of tuberculous meningitis in the last phase. The aim of this case report is to remind that TM must be considered in the differential diagnosis of intracranial infection in patients from endemic areas and the treatment should be initiated rapidly to prevent delayed diagnosis and lethal complications.
A Case Report on Complicated Tuberculous Meningitis
Cureus, 2017
Tuberculous meningitis (TBM) is associated with significant complications of central nervous system. It is accompanied by nonspecific and heterogeneous clinical symptoms. We focused on the significance of early diagnosis and prompt treatment. We describe a case of TBM in a 19-year-old Asian female. She had a progressive motor weakness with no sensory findings. She was started on antituberculous therapy. Her magnetic resonance imaging (MRI) contrast of dorsolumbar spine showed syringomyelia. Her culture and sensitivity for Mycobacterium tuberculosis (MTB) came negative. She was given a therapeutic trial of quinolones and Steroids. She had an uneventful recovery and was followed up for the past one year.
Clinical, Laboratory, and Radiological Evaluation of 32 Cases with Tuberculous Meningitis
Flora the Journal of Infectious Diseases and Clinical Microbiology
Introduction: Tuberculous meningitis is an important central nervous system infection, and it is the most severe clinical form of tuberculosis. Mycobacterium tuberculosis is the frequently isolated microorganism, and it is associated with high morbidity and mortality among central nervous system infections. Despite all the advances in medicine, diagnosis of tuberculous meningitis is still a significant problem. In our study, we aimed to evaluate clinical, microbiological and radiological features of the patients with tuberculous meningitis in detail. Materials and Methods: The study was designed as a retrospective study. A total of 32 patients diagnosed on the basis of clinical, microbiological and radiological criteria with tuberculous meningitis were included into the study. Patients were exposed to computed tomography scan and magnetic resonance imaging with the exception of two patients. Computed tomography scans were performed at the time of admission to the emergency department while magnetic resonance imagings were performed within the 48 hours after computed tomography scans. The data were analyzed with SPSS 24. Results: Eleven of the patients were diagnosed with gold standard methods. The pathogen microorganism was M. tuberculosis in all cases. The diagnoses of other patients were determined by clinical; microbiologic and radiologic estimations. Demographic findings-symptoms of the patients, laboratory findings-symptoms and the contribution of radiology to the diagnosis were evaluated. Particularly, when the contribution of radiology to the diagnosis was studied, it was found that especially magnetic resonance imaging was more useful than computed tomography. Conclusion: Central nervous system infections due to M. tuberculosis are frequently related to high morbidity and mortality. The gold diagnosis methods of the disease are; isolation of M. tuberculosis from the cerebrospinal fluid or seeing the microorganism in the fluid with EZN stain. Because of the low positivity rates in gold standard methods, radiologic methods such as magnetic resonance imaging can be used in tuberculous meningitis diagnosis.
Presentation of Tuberculous Meningitis
Journal of the Liaquat University of Medical and Health Sciences, 2020
Objective: To find out the frequency of presentation of Tuberculous meningitis in different stages and to assess the role of Cerebrospinal fluid analysis and Magnetic Resonance imaging in diagnosis. Methodology: This descriptive observational study was conducted at neurology ward at JPMC Karachi from July 2018 - December 2019. Diagnosed patients of tuberculous meningitis above 12 years of age included in the study and were classified into three stages. Stage 1 included non-specific symptoms like headache, vomiting, fever and anorexia without impaired level of consciousness. Stage 2 patients were altered level of consciousness or focal neurological deficit without coma. Stage 3 patients included coma, Cerebrospinal fluid analysis and Magnetic Resonance imaging findings were recorded. Mortality was recorded in Performa. Other variables like age, sex, residence etc. were recorded. Data was analyzed by SPSS version 24. Results: Patients were 110, presented in stage 1 were 30%( 33/110). ...
Tuberculous Meningitis in Childhood: New Aspects of Neurologic Complications
2016
Tuberculous Meningitis (TBM) is a severe manifestation of tuberculosis that represents 1% of the cases of infection by Mycobacterium tuberculosis. Children are among the other age groups the most affected and when present, HIV-1 is responsible for poorer prognosis. It was carried out a search on the databases of Pubmed, Lilacs and Scielo, looking for articles that approach the principals news aspects of neurologic complications caused by TBM. The literature cite as major neurologic fndings the hydrocephalus in approximately 80% patients, meningeal irritation, coma, seizures, intracranial pressure signs, cranial nerve palsy, hemiparesis and disorders in the movement. Neurologic sequelae occur in up to 50% of survivors and early diagnosis is crucial to reduce the occurrence of major functional losses. In this way, discussions presenting more specifc methods for TBM as well as better assessment of the signs and symptoms of the disease is necessary for a better prognosis and lower morta...
Radiologic and Clinical Findings in Tuberculous Meningitis
European Journal of General Medicine, 2004
We aimed to evaluate the radiologic and clinical findings of patients with tuberculous meningitis encountered during a 4-year period, retrospectively. Sixteen patients with tuberculous meningitis were admitted to our hospital. The diagnosis was based on abnormal neurologic symptoms and signs, cerebrospinal fluid findings, negative bacteria culture, and abnormalities on brain-imaging studies. CT and MR examinations were performed in 16 and 9 patients, respectively. A retrospective comparison was done between CT and MR findings. All patients had fever, lethargy, and some of them had cough. Neurologic presentations included increased intracranial pressure, vomiting, seizures, paresis, nuchal rigidity, and disturbance of consciousness. Acid-fast stain of cerebrospinal fluid for tuberculous bacilli was negative for all samples. All bacterial cultures of cerebrospinal fluid yielded no growth, with the exception of one that grew Mycobacterium tuberculosis. Radiologic findings compatible with tuberculous meningitis including hydrocephalus, basilar cistern enhancement and infarction was observed more clearly on MR than CT. Early diagnosis in tuberculous meningitis may prevent neurologic damage. Imaging studies is an important part of diagnosis and MR imaging should be performed as a first choice of imaging modalities in patients with tuberculous meningitis.