Chronic granulomatous meningitis with multiple cranial nerve lesions, hydrocephalus, stroke, sinus thrombosis, and epilepsy

Most frequently, chronic granulomatous meningitis (CGM) is caused by infect ious agents. However, in some cases the cause of CGM remains undetermined. It is unclear whether antimicrobial agents, including antituberculous drugs , are helpful in such cases. We describe a 61-year-old man who had multiple cranial nerve lesions, epilepsy sinus thrombosis, stroke, and hydrocephalu s attributable to CGM, Repeated extensive search for a causative agent in t he cerebrospinal fluid (CSF) and the meninges remained negative. Only a sin gle culture of the sputum revealed growth of Mycobacterium tuberculosis, wh ich prompted antituberculous therapy with isoniazid, rifampicin, and ethamb utol, After 6 months of therapy, neurologic abnormalities were slightly imp roved. We conclude that antimicrobial/antituberculous agents have only a mi nor short-term effect in long-lasting CGM of undetermined cause.