Abstract

Case Presentation

Spinal cord involvement in tuberculous meningitis: a case report and brief review of literature

Oriba Dan Langoya*, Adrian Mwota Nampogo and Andia Irene

Published: 15 March, 2022 | Volume 7 - Issue 1 | Pages: 001-004

Introduction: Tuberculosis (TB) continues to pose a significant public health problem worldwide. Tuberculous meningitis (TBM) is the most devastating form of extrapulmonary TB however other forms of central nervous system (CNS) disease include tuberculoma and spinal arachnoiditis. TBM carries high mortality even for a patient who is already receiving treatment. The difficulty in diagnosis often leads to a delay in treatment and subsequent mortality. The emergence of Xpert ultra has improved the rapid detection of MTB and rifampicin resistance in CSF and is the preferred diagnostic tool in TBM.
Case: In this case report we present a 33 years patient of concern who presented with progressive lower limb weakness associated with pain and paresthesia for 4 months, admitted via the Orthopedic unit with a diagnosis of spinal mass (meningioma, neurofibroma, or nerve sheath tumor) for which biopsy was done and revealed a chronic inflammatory process, necrotic bone lesions with no granulomas and no malignancy, he was later diagnosed with tuberculous meningitis and promptly started anti-tuberculous therapy with a dramatic recovery and improvement in neurological function.
Conclusion: Tuberculous meningitis conditions have high morbidity and mortality yet diagnosis and start of treatment continue to experience an important delay. Clinicians should keep in mind the limitations of clinical presentation due to pleiotropy and current diagnostics and should employ a combination of diagnostic modalities in addition to a high index of suspicion to prevent morbidity in patients with TBM.

Read Full Article HTML DOI: 10.29328/journal.jcicm.1001040 Cite this Article Read Full Article PDF

Keywords:

Tuberculous Meningitis, Spinal Cord, Human Immunodeficiency Virus (HIV)

References

  1. Tuberculosis (TB). https://www.who.int/news-room/fact-sheets/detail/tuberculosis
  2. Global Tuberculosis Report. 2020; 148. https://www.who.int/teams/global-tuberculosis-programme/data
  3. Pormohammad A, Nasiri MJ, McHugh TD, Riahi SM, Bahr NC. A Systematic Review and Meta-analysis of the Diagnostic Accuracy of Nucleic Acid Amplification Tests for Tuberculous Meningitis. J Clin Microbiol. 2019; 57: e01113-1118. PubMed: https://pubmed.ncbi.nlm.nih.gov/30944198/
  4. van Laarhoven A, Dian S, Ruesen C, Hayati E, Damen MSMA, et al. Clinical Parameters, Routine Inflammatory Markers, and LTA4H Genotype as Predictors of Mortality Among 608 Patients With Tuberculous Meningitis in Indonesia. J Infect Dis. 2017; 215: 1029-1039. PubMed: https://pubmed.ncbi.nlm.nih.gov/28419315/
  5. Thwaites GE, Bang ND, Dung NH, et al. Dexamethasone for the Treatment of Tuberculous Meningitis in Adolescents and Adults. N Engl J Med. 2004; 351: 1741-1751. PubMed: https://pubmed.ncbi.nlm.nih.gov/15496623/
  6. Chin JH, Musubire AK, Morgan N, Pellinen J, Grossman S, et al. Xpert MTB/RIF Ultra for Detection of Mycobacterium tuberculosis in Cerebrospinal Fluid. J Clin Microbiol. 2021; 57: e00249-19. PubMed: https://pubmed.ncbi.nlm.nih.gov/30944199/
  7. Shen Y, Yu G, Zhao W, Lang Y. Efficacy of Xpert MTB/RIF Ultra in diagnosing tuberculosis meningitis: A systematic review and meta-analysis. Medicine (Baltimore). 2021; 100: e26778-e26778. PubMed: https://pubmed.ncbi.nlm.nih.gov/34398057/
  8. Roth M, Johnson PRA, Rüdiger JJ, King GG, Ge Q, et al. Interaction between glucocorticoids and β2 agonists on bronchial airway smooth muscle cells through synchronised cellular signalling. Lancet. 2002; 360: 1293-1299. PubMed: https://pubmed.ncbi.nlm.nih.gov/12414205/
  9. Thwaites GE, Chau TTH, Stepniewska K, Phu NH, Chuong LV, et al. Diagnosis of adult tuberculous meningitis by use of clinical and laboratory features. Lancet. 2002; 360: 1287-1292. PubMed: https://pubmed.ncbi.nlm.nih.gov/12414204/
  10. Foppiano Palacios C, Saleeb PG. Challenges in the diagnosis of tuberculous meningitis. J Clin Tuberc other Mycobact Dis. 2020; 20: 100164. PubMed: https://pubmed.ncbi.nlm.nih.gov/32462082/
  11. Belorgey L, Lalani I, Zakaria A. Ischemic Stroke in the Setting of Tuberculous Meningitis. J Neuroimaging. 2006; 16: 364-366. PubMed: https://pubmed.ncbi.nlm.nih.gov/17032389/
  12. Thwaites GE, Hien TT. Tuberculous meningitis: many questions, too few answers. Lancet Neurol. 2005; 4: 160-170. PubMed: https://pubmed.ncbi.nlm.nih.gov/15721826/
  13. Bahr NC, Boulware DR. Methods of rapid diagnosis for the etiology of meningitis in adults. Biomark Med. 2014; 8: 1085-1103. PubMed: https://pubmed.ncbi.nlm.nih.gov/25402579/
  14. Seddon JA, Tugume L, Solomons R, Prasad K, Bahr NC, et al. The current global situation for tuberculous meningitis: epidemiology, diagnostics, treatment and outcomes. Wellcome open Res. 2019; 4: 167. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7029758/

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