Abstract Ref Number = APCP1113
TUBERCULOUS MENINGITIS AS DIFFERENTIAL DIAGNOSIS IN PROLONGED FEVER: A CASE REPORT
Rose Kusuma,Nina Dwi Putri,Irawan Mangunatmaja,Nastiti Kaswandani
Faculty of Medicine Universitas IndonesiaCipto Mangunkusumo Hospital
Background : Infections remain the most common cause of fever in general and prolonged fever in particular. The evaluation should follow a tiered approach. Tuberculosis (TB) should be considered in the differential diagnosis of prolonged fever in children. The diagnosis of TB meningitis (TBM) is suspected once neurologic signs appear. The proper diagnosis and early treatment is important since advanced stages are associated with poor outcomes.
Case Presentation Summary : A 16 years old, Human Immunodeficiency Virus (HIV) exposed girl had persistent fever 2 months prior to admission, no cough, gastrointestinal, or urogenital symptoms. Last one week, she complained headache, nausea, and vomit (no projectile). Her mother is a HIV positive since 2002 with a history of complete treatment of lymphadenitis TB 6 months ago. There was no abnormality found in the physical or neurological examination. She had normal laboratory but only elevated Estimated Sedimentation Rate (ESR). Evaluation of HIV status was negative. Interferon-y Release Assay (IGRA) was positive. The chest x-ray resulted in enlarging hillus lymph nodes and lung infiltrates. Cerebral Magnetic Resonance Imaging (MRI) with contrast was normal. Cerebrospinal fluid (CSF) tapping revealed slightly cloudy, lymphocytic pleocytosis, elevated protein, and low glucose level. Although Poymerase Chain Reaction (PCR) TB and TB cultures from CSF were still pending, she was given a presumed diagnosis of TBM and placed on rifampin (R), isoniazid (INH), pyrazinamide (Z), ethambutol (E), and dexamethasone. After 5 days of treatment, she had no fever or headache, she was discharged in less than 2 weeks after admission.
Learning Points/Discussion : This report highlights the challenges in identifying TBM as one of differential diagnosis of prolonged fever. An appropriate history of TB risk factors and neurological symptoms should raise the suspicion of TBM in case of prolonged fever.
Keywords: prolonged fever tuberculous meningitis cerebrospinal fluid analysis