Early diagnosis of tuberculous meningitis by detection of antigen-specific interferon-γ production in the cerebrospinal fluid by using QuantiFERON^® TB-2G

Abstract

A 53-year-old man without a history of tuberculosis was admitted to our hospital because of disturbances in consciousness. He was diagnosed with meningitis on the basis of the following: fever, nuchal rigidity, and increase in the number of cells in the cerebrospinal fluid. Ceftriaxone was therefore administered. However, his level of consciousness progressively deteriorated, and finally, he became comatose. He was therefore intubated and admitted to the ICU. The ineffectiveness of antibiotic treatment, progressive deterioration of consciousness, development of hydrocephalus and meningeal enhancement primarily around the basilar cisterns —as revealed by gadolinium-enhanced magnetic resonance (MR) images— strongly suggested the presence of tuberculous meningitis. We therefore initiated anti-tuberculous chemotherapy and steroid treatment. The cells in the cerebrospinal fluid were subjected to QuantiFERON^® TB-2G (QFT-2G) test, and positive results were obtained on the 15th day. Mycobacterium tuberculosis was detected in a culture of a cerebrospinal fluid sample on the 51st day. Although anti-tuberculous chemotherapy was continued for 6 months, the patient barely regained consciousness and was severely disabled; therefore, tracheostomy and gastrostomy were required for the management of the patient. The QFT-2G test with cerebrospinal fluid cells is useful for the early diagnosis of tuberculous meningitis.