Granulomatous angiitis presenting as chronic meningitis and ventriculitis

A 35-year-old woman had a diffuse encephalopathy with increased intracranial pressure and chronic lymphocytic meningitis. Hypoglycorrhachia and ventricular accumulation of tracer on radionuclide brain scanning suggested an infection. Cerebral cortical and leptomeningeal biopsies were done when she failed to improve with antituberculous therapy, but were not diagnostic. Granulomatous angiitis of the nervous system was diagnosed at postmortem examination and should be considered in the differential diagnosis of culture-negative chronic meningitis.