Tuberculous meningitis with pulmonary military tuberculosis: case report
Alaa Zammiti1,&, Bassem Chatbri1, Azza Yedeas1, Olfa Djebbi1, Mounir Haggui1, Mehdi Ben Lassoued1, Khaled Lamine1
1Emergency Department, Military Hospital, Tunis, Tunisia
Alaa Zammiti, Emergency Department, Military Hospital, Tunis, Tunisia
central nervous system (CNS) Tuberculosis (TB) is the most dangerous form of extra-pulmonary TB. It occurs in approximately 1% of all patients with active tuberculosis (1). It includes meningitis, intracranial tuberculomas and abscesses. The diagnosis and treatment of Tuberculosis Meningitis (TBM) is still a clinical challenge. We report a case of TBM with pulmonary military tuberculosis.
a 30-year-old male was admitted in the Emergency Department with complaints of high grade fever, weight loss, decreased appetite and generalized weakness for 1 month. On admission, the patient looked ill, he was confused, disoriented. Physical examination revealed: temperature 39░C, heart rate: 110 beats/min, blood pressure: 150/60 mmHg, respiratory rate: 18 inspirations/min. He had neck stiffness, the auscultation of the lungs was normal. The Investigations show: White blood cell count: 6360 element/L, with 79% neutrophils and 6,8% lymphocytes, Hb 13 g/dl, Platelets: 290000/mm3,
C-reactive protein: 103 mg/l, Na+: 121 mmol/l, glycemia: 7,5 mmol/l , creat:
66 Ámol/l. Computed tomography scan of the brain was normal. The cerebrospinal fluid test was clear, with leucocyte count at 10 103/ml, the glucose level was: 0.85 mmol/l (ratio 0,15) and the protein level was: 1, 98g/l. HIV and Hepatitis B and C serology were negative.
chest X-Ray showed typical milliary pattern. Thus, the diagnosis of TBM was highly suspected and antituberculous chemotherapy, with isoniazid, rifampicin, ethambutol and pyrazinamide associated with dexamethasone was initiated. Clinical improvement was noted after the first week of therapy.
TB is still a major public health problem in the world, and there is a rising tendency of extra-pulmonary TB incidences especially in immune suppressed adults. The specificity of our patient is that no predisposing or associated conditions have been documented.
1st International Military Congress of Tropical Medicine and Sub-Saharan Diseases ()
Dates: 23 Oct 16 - 25 Oct 16
Contact person: Pr Salem Bouomrani (Salembouomrani@yahoo.fr)