Diagnosis and treatment of complicated tubercular meningitis

A 41-year-old woman was seen in no acute distress with an infected ventricu loperitoneal shunt. She underwent several revisions of the shunt but was re admitted to the hospital with nausea, vomiting, and neurologic sequelae. Re sults of spinal fluid analysis were white blood cells 68/mm(3) (25% neutrop hils), glucose less than 20 mg/dl, and protein 513 mg/dl. Cerebrospinal flu id, aerobic and anaerobic, and blood cultures were negative. Three weeks la ter the patient suffered a seizure and was prescribed antitubercular agents for a presumed diagnosis of tubercular meningitis. One week later, chest w ound culture from her first visit suggested Mycobacterium tuberculosis, whi ch was confirmed by DNA probe; cerebrospinal fluid culture eventually grew the organism. The patient fared well once she received antituberculosis age nts. The time between first contact and treatment in the hospital delayed t herapy.