Diagnosis and Treatment of Complicated Tubercular Meningitis

• Published in: Pharmacotherapy 1999-10, Vol.19 (10), p.1167-1172
• Main Authors: Kelly, Julia J., Horowitz, Edward A., Destache, Christopher J., Fruin, Alan H., Long, Vicki A.
• Format: Article
• Language: English
• Subjects: Adult; Aminoglycosides; Anti-Bacterial Agents - therapeutic use; Anticonvulsants - therapeutic use; Bacterial diseases; Bacterial diseases of the nervous system. Bacterial myositis; Biological and medical sciences; Female; Human bacterial diseases; Humans; Infectious diseases; Medical sciences; Mycobacterium tuberculosis; Mycobacterium tuberculosis - physiology; Phenytoin - therapeutic use; Seizures - drug therapy; Seizures - etiology; Tuberculosis and atypical mycobacterial infections; Tuberculosis, Meningeal - complications; Tuberculosis, Meningeal - diagnosis; Tuberculosis, Meningeal - drug therapy; Vancomycin - therapeutic use
• ISSN: 0277-0008; 1875-9114
• DOI: 10.1592/phco.19.15.1167.30575

A 41‐year‐old woman was seen in no acute distress with an infected ventriculoperitoneal shunt. She underwent several revisions of the shunt but was readmitted to the hospital with nausea, vomiting, and neurologic sequelae. Results of spinal fluid analysis were white blood cells 68/mm3 (25% neutrophils), glucose less than 20 mg/dl, and protein 513 mg/dl. Cerebrospinal fluid, aerobic and anaerobic, and blood cultures were negative. Three weeks later the patient suffered a seizure and was prescribed antitubercular agents for a presumed diagnosis of tubercular meningitis. One week later, chest wound culture from her first visit suggested Mycobacterium tuberculosis, which was confirmed by DNA probe; cerebrospinal fluid culture eventually grew the organism. The patient fared well once she received antituberculosis agents. The time between first contact and treatment in the hospital delayed therapy.