[A case of tuberculous meningoencephalomyelitis]
O A Kicherova1, L I Reikhert1, E E Ivanova2
1Tyumen State Medical University, Tyumen, Russia.
Zhurnal Nevrologii I Psikhiatrii Imeni S.S. Korsakova
|April 29, 2022
Summary
Central nervous system tuberculosis is a significant challenge. This case highlights delayed diagnosis due to atypical presentation and initial negative tests, emphasizing treatment guided by clinical suspicion.
Area of Science:
- Neurology
- Infectious Diseases
- Medical Case Reports
Background:
- Central nervous system tuberculosis (TB) is a major cause of extrapulmonary TB, posing significant diagnostic and therapeutic challenges.
- Despite advanced diagnostics like PCR and imaging, timely diagnosis remains difficult due to atypical presentations and low sensitivity of initial tests.
Observation:
- A case of tuberculous meningoencephalomyelitis in an HIV-negative female patient is presented, with no signs of visceral or pulmonary TB.
- Diagnosis was complicated by repeatedly negative cerebrospinal fluid PCR for Mycobacterium tuberculosis, despite clinical suspicion.
Findings:
- Treatment initiated 'ex juvantibus' (based on presumed efficacy) led to rapid neurological improvement and near-complete recovery.
- Mycobacterium tuberculosis was confirmed via PCR on day 3 and microbiologically on day 12 of anti-TB therapy.
Implications:
- This case underscores the importance of clinical suspicion in diagnosing central nervous system TB, even with negative initial laboratory results.
- Early empirical treatment can be life-saving in suspected cases of tuberculous meningoencephalomyelitis, guiding further diagnostic confirmation.
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