Introduction. Tuberculous meningitis is a difficult disease to diagnose, most often presenting as a subacute meningitis.
Case presentation. A 35-year-old patient, without personal pathological history, presented urgently for a seromucous cough, fever, and loss of appetite for about a week. On admission, her general condition was affected, she was cachectic, bradylalic, febrile, with pale skin, no signs of meningeal irritation. Chest X-ray detected imprecisely delimited nodular opacities of medium intensity projected in the upper half of the bilateral hemithorax, with varying sizes up to 10mm. At 12 hours after admission, the patient became agitated and confused, which is why she is referred for a neurological consultation that highlighted meningeal signs. Meningitis was suspected and she was referred to the Infectious Diseases Hospital. The bacteriological examination of sputum revealed acid-alcohol-resistant bacilli – negative on direct examination and cultures. At the PCR DNA test, Mycobacterium tuberculosis was detected in the cerebrospinal fluid. Antituberculosis treatment was initiated, 7/7 regimen. On the third day after admission, the patient developed a quasi-plegic motor deficit of the lower limbs and a positive Babinski sign. Cranio-cerebral and dorso-lumbar magnetic resonance imaging (MRI) revealed leptomeningitis changes with cloazonated appearance from D1 to D9, with extensive contrast uptake along the cauda equina and tuberculosis D11 transverse myelitis.
Conclusions. The case shows the impressive evolution of a patient under correctly managed treatment and the importance of the interdisciplinary collaboration between pulmonologist – infectious disease specialist – neurosurgeon – neurologist – rehabilitation doctor.
Keywords: meningitis, myelitis, Mycobacterium tuberculosis, antituberculosis, rehabilitation.
Full text sources https://doi.org/10.31688/ABMU.2024.59.2.10
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Address for correspondence:
Stefan SANDULACHE
Department I Pneumology, Clinical Hospital of Pneumophthisiology
Address: 30 Dr. Iosif Cihac Str., 700115, Iasi, Romania
E-mail: stefan.sandulache94@yahoo.com
