Tuberculous meningitis diagnosed on repeat cerebrospinal fluid analysis after unremarkable initial findings: a case report

Abstract

Tuberculous meningitis (TBM) is a severe and often fatal form of extrapulmonary tuberculosis. We describe a case in which the initial cerebrospinal fluid (CSF) analysis showed no specific abnormalities, but a diagnosis was established after repeat CSF evaluation. A 41-year-old female presented with a 10-day history of persistent fever and headache. Initial CSF analysis demonstrated an opening pressure of 150 mmH2O, a white blood cell (WBC) count of 10/µL, a glucose level of 50 mg/dL, and a protein level of 31.4 mg/dL. Despite treatment with an antiviral agent and doxycycline, her symptoms did not improve. A repeat CSF analysis demonstrated an opening pressure of 120 mmH2O, an elevated WBC count of 140/µL (55% lymphocytes), a glucose level of 52 mg/dL, and an elevated protein level of 201.6 mg/dL, which was highly suggestive of TBM. This case highlights the importance of repeat CSF analysis based on clinical judgment when diagnosing TBM.