A case of meningitis associated with difficulty in assessing the efficacy of antituberculosis treatment due to comorbid secondary hydrocephalus

Abstract

A 44-year-old man developed headache, slight fever, and memory disturbance eight months ago, and he was admitted to our hospital due to abnormal behavior and disturbed consciousness. Meningitis was suspected because of disturbed consciousness and neck stiffness. Considering his immunocompromised backgrounds, long-lasting symptoms, imaging findings, and cerebrospinal fluid (CSF) findings, tuberculous meningitis was the most probable diagnosis. Nevertheless, we failed to detect the pathogen by culture test, nested PCR, cytodiagnosis, and meninges and brain biopsy. Administration of antituberculosis drugs successfully reduced the patient's CSF cell count but his symptoms remained unchanged. On the other hand, the symptoms gradually improved by VP shunt for secondary hydrocephalus. Here we present this unusual case of meningitis and discuss the difficulties in making a definite diagnosis of tuberculous meningitis and those in assessing the efficacy of antituberculosis treatment under the presence of secondary hydrocephalus.