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A Rare Presentation of Tubercular Meningitis as Persistent Neutrophilic Meningitis

Tarun Ralot1, Chander Bafna1, Surender Singh1

  • 1Department of Neurology, RNT Medical College, Udaipur, Rajasthan, India 313001.

The Malaysian Journal of Medical Sciences : MJMS
|January 31, 2018
PubMed

Insights

Persistent neutrophilic meningitis is rare in tubercular meningitis (TBM). This case highlights TBM presenting with persistent neutrophilic meningitis in an immunocompetent patient, challenging typical TBM CSF findings.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Cerebrospinal Fluid Analysis

Background:

  • Persistent neutrophilic meningitis is defined by cerebrospinal fluid (CSF) neutrophilic pleocytosis lasting over a week despite empirical antimicrobial therapy.
  • Tubercular meningitis (TBM) typically presents with lymphocytic pleocytosis, with neutrophilic predominance rarely persisting beyond one week.

Observation:

  • A 25-year-old immunocompetent male presented with clinical meningitis and CSF analysis showing persistent neutrophilic pleocytosis.
  • Brain MRI revealed granulomas, leading to the initiation of anti-tubercular therapy (ATT).

Findings:

  • Despite ATT, CSF analysis showed a reduced total cell count but continued neutrophilic predominance.
  • The patient experienced clinical improvement and completed a full course of ATT.

Implications:

  • This case underscores the rare presentation of TBM as persistent neutrophilic meningitis.
  • It emphasizes the need to consider TBM in persistent neutrophilic meningitis, even in immunocompetent individuals.
  • Highlights the diagnostic challenge and management of atypical TBM presentations.
Keywords:
anti-tubercular treatmentgranulomaslymphocytic pleocytosispersistent neutrophilic meningitistubercular meningitis

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