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Washington University Experience | INFECTION | Bacteria | TB - Meningitis & Tuberculoma | 7A0 Case 7 History
Case 7 History ---- The patient is a 55-year-old man with a several month history of altered mental status and 30-pound weight loss without fevers, chills or night sweats. He had been previously treated for presumed sinusitis, had a tick bite and a pruritic rash, and had a dental abscess treated with two weeks of amoxicillin. He developed slurred speech and staggering, and was taken to an outside hospital. CSF was remarkable for an increased white blood cell count (WBC) of 160 but CSF cultures were negative. He was discharged with a presumptive diagnosis of viral meningitis and encephalitis. Later he returned with fever. CSF showed WBC count of 600. MRI exam showed leptomeningeal enhancement, sulcal FLAIR hyperintensity, and mildly prominent ventricles, prompting treatment with vancomycin, ceftriaxone, and doxycycline. However, a week later, his condition declined, with strange behavior and new hallucinations. Later exhaustive workup for all variety of viruses and bacteria failed to identify a candidate organism. He was then biopsied and a diagnosis of TB meningoencephalitis made.
