TB meningitis

• related: TB meningitis, meningitis

This patient likely has tuberculous meningitis, a highly fatal form of extrapulmonary tuberculosis (TB). Manifestations typically begin with 2-3 weeks of prodromal symptoms (eg, headache, low-grade fever, lassitude) followed by progressive signs of meningeal irritation (eg, nuchal rigidity, vomiting, confusion). Cranial nerve palsies, coma, and seizures may occur. Choroidal tubercles (yellow-white nodules near the optic disc) are often detected via funduscopic examination.

Suspicion for tuberculous meningitis is typically raised when brain imaging reveals basilar meningeal enhancement and cerebrospinal fluid (CSF) examination shows the following:

• Elevated protein (>250 mg/dL, generally 100-500 mg/dL)
• Low glucose (<10 mg/dL)
• Lymphocytic pleocytosis
• Elevated adenosine deaminase

Definitive diagnosis requires serial lumbar punctures with CSF examination for acid-fast bacilli using smear and culture.