Diagnostic Challenges and Dilemmas in Tuberculous Meningitis

Supavit Chesdachai, Benjamin Katz, Smarika Sapkota

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations


Tuberculosis is a global burden with an unacceptably high mortality rate, especially in low- and middle-income countries. We reported the case of 34-year-old Somali female with no significant risk factors who initially presented with headache and blurred vision. The patient subsequently developed altered mental status and significant vision changes. Initial lumbar puncture showed lymphocytic pleocytosis with negative gram stain, acid-fast bacilli stain, and culture. Initial polymerase chain reaction for tuberculosis was negative. The patient worsened despite receiving broad-spectrum antibiotics. The patient had a prolonged hospital course and eventually required lumbar drain placement for hydrocephalus. Repeated polymerase chain reactions for Mycobacterium tuberculosis from the lumbar drain samples was positive, and the diagnosis of tuberculous meningitis was confirmed. The patient improved after lumbar drain placement and treatment with isoniazid, rifampin, pyrazinamide, ethambutol and steroid tapering. This case illustrated the challenge of diagnosing tuberculous meningitis.

Original languageEnglish (US)
Pages (from-to)372-377
Number of pages6
JournalAmerican Journal of the Medical Sciences
Issue number6
StatePublished - Jun 2020

Bibliographical note

Publisher Copyright:
© 2020 Southern Society for Clinical Investigation


  • Tuberculosis, Mycobacterium tuberculosis
  • Tuberculous meningitis


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