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Persistence Pays : Diagnosing Tuberculous Meningitis after 11 Negative Polymerase Chain Reaction Evaluations

Obara, Kazuki LU orcid ; Tsuboi, Takashi ; Mori, Yu ; Sanda, Akihiro ; Mouri, Naohiro ; Takagi, Shinnosuke ; Aoki, Shinichiro and Katsuno, Masahisa LU (2025) In Internal Medicine 64. p.931-936
Abstract

Managing tuberculous meningitis (TBM) is challenging because of its poor prognosis and the difficulty in making an early diagnosis due to the low sensitivity of cerebrospinal fluid (CSF) polymerase chain reaction (PCR) evaluations. A 75-year-old woman presented with fatigue and multiple enlarged lymph nodes and was initially suspected of having metastatic cancer of unknown primary origin. Differential diagnoses included carcinomatous meningitis, neurosarcoidosis, and TBM, as suggested by the presence of multiple enhancing cerebral nodules. Despite 11 negative PCR evaluations, including nested PCR of CSF and biopsied lymph nodes within the first 3 days of empirical anti-tubercular treatment, TBM was eventually confirmed by CSF cultures... (More)

Managing tuberculous meningitis (TBM) is challenging because of its poor prognosis and the difficulty in making an early diagnosis due to the low sensitivity of cerebrospinal fluid (CSF) polymerase chain reaction (PCR) evaluations. A 75-year-old woman presented with fatigue and multiple enlarged lymph nodes and was initially suspected of having metastatic cancer of unknown primary origin. Differential diagnoses included carcinomatous meningitis, neurosarcoidosis, and TBM, as suggested by the presence of multiple enhancing cerebral nodules. Despite 11 negative PCR evaluations, including nested PCR of CSF and biopsied lymph nodes within the first 3 days of empirical anti-tubercular treatment, TBM was eventually confirmed by CSF cultures 32 days later. This case highlights the need for repeated sampling.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Internal Medicine
volume
64
pages
931 - 936
publisher
Japanese Society of Internal Medicine
external identifiers
  • scopus:105000107295
  • pmid:39135250
ISSN
0918-2918
DOI
10.2169/internalmedicine.4087-24
language
English
LU publication?
yes
id
90653240-7260-4649-8682-26f1b038aca7
date added to LUP
2024-09-28 16:03:27
date last changed
2025-07-18 10:52:28
@article{90653240-7260-4649-8682-26f1b038aca7,
  abstract     = {{<p>Managing tuberculous meningitis (TBM) is challenging because of its poor prognosis and the difficulty in making an early diagnosis due to the low sensitivity of cerebrospinal fluid (CSF) polymerase chain reaction (PCR) evaluations. A 75-year-old woman presented with fatigue and multiple enlarged lymph nodes and was initially suspected of having metastatic cancer of unknown primary origin. Differential diagnoses included carcinomatous meningitis, neurosarcoidosis, and TBM, as suggested by the presence of multiple enhancing cerebral nodules. Despite 11 negative PCR evaluations, including nested PCR of CSF and biopsied lymph nodes within the first 3 days of empirical anti-tubercular treatment, TBM was eventually confirmed by CSF cultures 32 days later. This case highlights the need for repeated sampling.</p>}},
  author       = {{Obara, Kazuki and Tsuboi, Takashi and Mori, Yu and Sanda, Akihiro and Mouri, Naohiro and Takagi, Shinnosuke and Aoki, Shinichiro and Katsuno, Masahisa}},
  issn         = {{0918-2918}},
  language     = {{eng}},
  pages        = {{931--936}},
  publisher    = {{Japanese Society of Internal Medicine}},
  series       = {{Internal Medicine}},
  title        = {{Persistence Pays : Diagnosing Tuberculous Meningitis after 11 Negative Polymerase Chain Reaction Evaluations}},
  url          = {{http://dx.doi.org/10.2169/internalmedicine.4087-24}},
  doi          = {{10.2169/internalmedicine.4087-24}},
  volume       = {{64}},
  year         = {{2025}},
}