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Chronic granulomatous meningitis with multiple cranial nerve lesions hydrocephalus, stroke, sinus thrombosis, and
J Finsterer1, A Kladosek, I E Nagelmeier
1Neurological Department, NKH Rosenhügel, Vienna, Austria.
Abstract:
Most frequently, chronic granulomatous meningitis (CGM) is caused by infectious agents. However, in some cases the cause of CGM remains undetermined. It is unclear whether antimicrobial agents, including antituberculous drugs, are helpful in such cases. We describe a 61-year-old man who had multiple cranial nerve lesions, epilepsy, sinus thrombosis, stroke, and hydrocephalus attributable to CGM. Repeated extensive search for a causative agent in the cerebrospinal fluid (CSF) and the meninges remained negative. Only a single culture of the sputum revealed growth of Mycobacterium tuberculosis, which prompted antituberculous therapy with isoniazid, rifampicin, and ethambutol. After 6 months of therapy, neurologic abnormalities were slightly improved. We conclude that antimicrobial/ antituberculous agents have only a minor short-term effect in long-lasting CGM of undetermined cause.
Insights
Antimicrobial and antituberculous drugs offer minimal short-term benefit for chronic granulomatous meningitis (CGM) of unknown cause. This study highlights the limited efficacy of these treatments in persistent, undiagnosed cases of CGM.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Chronic granulomatous meningitis (CGM) is often infectious but can be of undetermined origin.
- The efficacy of antimicrobial agents, including antituberculous drugs, in undiagnosed CGM is not well established.
- CGM can lead to severe neurological complications.
Observation:
- A 61-year-old man presented with multiple cranial nerve lesions, epilepsy, sinus thrombosis, stroke, and hydrocephalus due to CGM.
- Extensive investigations of cerebrospinal fluid and meninges failed to identify a causative agent.
- Mycobacterium tuberculosis was identified in a single sputum culture, leading to antituberculous therapy.
Findings:
- Antituberculous therapy with isoniazid, rifampicin, and ethambutol was initiated.
- Neurological abnormalities showed only slight improvement after six months of treatment.
- The study suggests limited short-term effectiveness of antimicrobial/antituberculous agents in long-standing CGM of undetermined etiology.
Implications:
- Antimicrobial and antituberculous therapies may have a limited role in managing chronic granulomatous meningitis when the cause remains elusive.
- Further research is needed to explore alternative or adjunctive treatment strategies for undiagnosed CGM.
- This case underscores the challenges in treating persistent meningitis of unknown origin.