Development tuberculous meningitis during chemotherapy for CD5-positive diffuse large B-cell lymphoma

Area of Science:

• Oncology
• Infectious Diseases
• Neurology

Background:

• A 62-year-old female patient was diagnosed with CD5(+) diffuse large B-cell lymphoma.
• The patient initiated treatment with the R-CHOP regimen.

Observation:

• The patient developed headache, low-grade fever, and progressive deterioration of consciousness during R-CHOP therapy.
• Cerebrospinal fluid (CSF) analysis showed elevated white blood cells and protein levels, initially treated as acute meningitis.
• Despite antibacterial, antiviral, and intrathecal chemotherapy, symptoms persisted, prompting further investigation.

Findings:

• Central nervous system (CNS) involvement was suspected, leading to intrathecal chemotherapy with methotrexate and dexamethasone, resulting in transient improvement.
• Empirical anti-tuberculosis treatment was initiated due to persistent fever and altered consciousness.
• Tubercle bacilli were confirmed in CSF culture after 23 days, establishing a diagnosis of tuberculous meningitis.

Implications:

• Impaired cellular immunity in lymphoma patients elevates the risk of opportunistic infections like tuberculosis.
• Tuberculous meningitis should be strongly considered in the differential diagnosis of lymphoma patients presenting with meningitis.
• This case highlights the importance of prompt and comprehensive diagnostic evaluation in immunocompromised patients with neurological symptoms.