Akademik Veri Yönetim Sistemi
World Academic Congress of Emergency Medicine 2023, Antalya, Türkiye, 28 - 31 Ekim 2023, cilt.1, ss.724, (Tam Metin Bildiri)
Is Mycobacterium
tuberculosis a life-threatening disease yet?
Tuberculosis is one of the oldest diseases, caused by Mycobacterium tuberculosis and effect
every organ, especially the lungs. Although it usually has a chronic course,
delayed cases may present with an acute presentation.
Case: Thirty-year-old Indian male patient applied to
emergency department with complaints of headache, visual disturbance, and
confusion. He came to Türkiye from India 25 days ago. Headache and visual
disturbance started 15 days ago and gradually increased. Confusion developed
for the last 5 days. Physical examination; he was confused, lethargic, non-cooperative,
non-oriented, speaking as meaningless sounds, Glasgow Coma Scale:11, Blood
presssure:149/93mmHg, Fever:37.7°C, Heart rate:144/min. Neck stiffness, Kerning
and Brudzinski signs were positive. Pupillary was anisochoric, right eye was
mydriatic, bilateral outward gaze limitation were observed.
Cranial magnetic resonance (MRI): bilateral
frontotemporoparietal and leptomeningeal enhancements are present. Contrast
enhancements were detected in bilateral 6th cranial nerve, bilateral 9th
cranial nerve, prominent trigeminal nerves on the right, 7th and 8th cranial
nerve traces on the left, bilateral optic nerve prechiasmatic segment and basal
cisternae. In cerebrospinal fluid (CSF) examination; 12 Erythrocytes/mm3, 110
Leukocytes/mm3 (95% lymphocytes) were seen, CSF protein 276.10 mg/dL, CSF
glucose 13 mg/dL (Simultaneous blood glucose: 110 mg/dL). With the diagnosis of
tuberculous meningitis, standard anti-tuberculosis treatment (isoniazid 300
mg/day, rifampicin 600 mg/day, pyrazinamide 2000 mg/day, ethambutol 1500
mg/day) and dexamethasone 16 mg/day was initiated.
After the 2nd week of the treatment, the patient regained
consciousness. He started to talk meaningfully and walk with support. In the
control cranial MRI taken at the 3rd week of the treatment: a significant
decrease in pathological contrast enhancements was observed. At the end of 40
days, Mycobacterium tuberculosis complex
yielded in the CSF culture. Antibiograms of ethambutol, isoniazid, streptomicin
and rifampin were found sensitive. After clinical recovery he was discharged to complete his anti-tuberculosis
treatment to 18 month. Despite recovery unfortunately bilateral vision loss
remained as a sequela.
Conclusion: Tuberculous meningitis is the form of tuberculosis disease with the highest morbidity and mortality rates. The nonspecific symptoms and signs of the disease may lead delay in diagnosis. In endemic areas it should be taken in mind in nearly every differential diagnosis.
Keys: tuberculosis, meningitis, cerebrospinal fluid