Case report demonstrates delayed emergence of diagnostic cerebrospinal fluid abnormalities in tuberculous meningitis, highlighting the clinical necessity of repeat lumbar puncture.
Key Points
To report a case of tuberculous meningitis diagnosed through repeat cerebrospinal fluid analysis following initially unremarkable diagnostic tests.
Evaluated the clinical progression and diagnostic workup of a 41-year-old female presenting with a 10-day history of persistent fever and headache.
Performed sequential lumbar punctures to measure opening pressure, cell counts, glucose, and protein levels before and after empiric antimicrobial treatment.
Initial CSF evaluation showed normal baseline parameters: opening pressure of 150 mmH2O, WBC count of 10/µL, glucose of 50 mg/dL, and protein of 31.4 mg/dL.
Repeat CSF evaluation following nonresponse to antiviral and antibiotic therapy revealed an opening pressure of 120 mmH2O, WBC count of 140/µL (55% lymphocytes), glucose of 52 mg/dL, and protein of 201.6 mg/dL.