Tubercular meningitis

Twenty-two year old man, was admitted with a nine day history of fever,

chills, sleepiness, headache and neck stiffness. Known for excessive consumption

of alcohol, the patient appeared dehydrated and malnourished.

He had a dental implant surgery five days before admission. On admission:

temperature was 41 degrees, Glasgow coma scale 13 with marked neck

stiffness. Cerebrospinal fluid was clear

with an opening pressure of 38 cm

and 610 white cells per cubic millimeter

(65% neutrophils, 35% lymphocytes).

The glucose cerebrospinal

fluid/ blood ratio was 0.9/7 mmol/l,

cerebrospinal fluid lactate was 8.8

mmol/l, and cerebrospinal fluid protein

was 182 mg/dl. Normal chest

radiography. Tuberculin skin test was

negative. Serum quantiFERON TB

Gold was negative. Negative for infection

with human immunodeficiency

virus. Mycobacterium tuberculosis

complex polymerase chain reaction

was obtained from cerebrospinal

fluid and was positive. He started

antituberculous therapy1 and his

headache and confusion improved

over the course of the next few days.