Clinical Management of Pathogen-Negative Tuberculous Meningitis in Adults: A Series Case Study

Abstract

Tuberculosis remains a serious world public health problem. Tuberculous meningitis (TBM) is the one of most severe forms of extrapulmonary tuberculosis. However, the insensitivity and time-consuming requirement of culturing the pathogen Mycobacterium tuberculosis, the traditional “gold standard” diagnostic test for TBM, often delays timely diagnosis and treatment, resulting in high disability and mortality rates. In our series case study, we present five pathogen-negative TBM cases who received empirical anti-tuberculosis therapy with a good clinical outcome. We describe in detail the clinical symptoms, laboratory test results, and imaging findings of the five patients from symptom onset to dynamic follow-up. We then summarize the similarities of the clinical characteristics of the presented patients, as well as shared features in laboratory and imaging tests, and proceed to analyze the challenges in the timely diagnosis of TBM. Finally, we argue that monitoring of cerebrospinal fluid markers and imaging are critical for the diagnosis and treatment of TBM, and emphasize the importance of differential diagnosis in cases when tuberculous meningitis is highly suspected despite negative findings for that etiology.

Tuberculous meningitis initially manifesting as acute areflexic paraparesis: A case report

“…All the other diagnoses were exhausted, and they were started on a trial of empirical anti‐Tuberculous treatment that significantly improved their condition. 15 Likewise, our patient also displayed symptoms of paraparesis and areflexia along with worsening of his neurological status. His TB screening was negative and despite that, he showed radical improvement with anti‐tuberculous therapy that resulted in the complete resolution of symptoms, which justifies this point.…”

“…In a recent case series study published in October 2022 in China, five patients were followed up who exhibited CNS symptoms with no pathogenic isolation of TB and negative imaging. All the other diagnoses were exhausted, and they were started on a trial of empirical anti‐Tuberculous treatment that significantly improved their condition 15 . Likewise, our patient also displayed symptoms of paraparesis and areflexia along with worsening of his neurological status.…”