Psychosis secondary to tuberculosis meningitis

Abstract

We report a case of a 19-year-old immunocompetent Malay woman who presented with a worsening psychotic disorder of 1-year duration. She initially presented with social isolation with subsequent mutism and stupor. Physical examination revealed a stuporous, emaciated, dehydrated woman with Glasgow Coma Scale of 11/15 (E4V2M5). She had a blank stare, mutism and akinesia. Motor examination revealed upper motor neuron findings. Neck stiffness was present, however, Kernig's and Brudzinski's signs were negative. There were no other findings on other systems. Brain imaging and EEG were normal. Cerebrospinal fluid investigations revealed positive cerebrospinal fluidMycobacterium tuberculosisPCR (MTB PCR). The patient was treated with empirical antituberculosis drugs and steroids. On follow-up visit 1 month later, her psychotic symptoms had fully resolved. She was able to ambulate and care for herself; she was unable to recall the symptoms she had experienced before and during admission.

Psychosis in Tuberculous Meningitis: A Case Series

“…[9,10] TBM per se has been observed to present as psychosis. [11,12] Pyrazinamide and rifampicin have linked to ATT-induced hepatic encephalopathy. [13] Furthermore, steroid is known to precipitate or induce psychosis in TBM.…”