A fatal case of tuberculous meningitis in a child with juvenile idiopathic arthritis: a diagnostic challenge
Articles > Article · 2017
Authors: Zümrüt ŞAHBUDAK BAL, Pınar YAZICI ÖZKAYA, Semra SEN, Cenk ERASLAN, Cengiz ÇAVUŞOĞLU, Bülent KARAPINAR, Fadil VARDAR
REVISTA DA SOCIEDADE BRASILEIRA DE MEDICINA TROPICAL, Journal Indexed in SCI Expanded, International, 2017, vol 50, pp 709-711
DOI: 10.1590/0037-8682-0410-2016
Summary
The prognosis of tuberculous meningitis, a rare form of extrapulmonary tuberculosis, depends on the stage of treatment initiation. We report a fatal case of tuberculous meningitis. The patient had received successive tumor necrosis factor (TNF) antagonists and abatacept to treat juvenile idiopathic arthritis, with negative results for polymerase chain reaction and acid-fast bacilli on smear, had normal cerebrospinal fluid (CSF) adenosine deaminase and glucose levels. Six weeks post-admission, the CSF culture demonstrated Mycobacterium tuberculosis. The altered immunological responses caused by anti-TNF treatment made the diagnosis challenging. Clinicians should bear this in mind and, if suspected, treatment should be initiated immediately.