Severe Tubercular Meningovasculitis Presenting as Fatal Brainstem Hemorrhage in a Young Female: A Rarity
Year: 2023
Type: article
Study design: Case Report
Abstract: were normal. She had hypoalbuminemia with albumin of 125 mEq/L (norma1 35-145 mEq/L) and hypocalcemia ranging from 8.2 to 8.7 mg/dL with normal serum procalcitonin level. The serum and urine osmolality were normal. Enzyme-linked immunosorbent assay (ELISA) test for cytomegalovirus (CMV) immunoglobulin M (IgM) antibody, toxoplasma antibody [Immunoglobulin G (IgG) and IgM] and cysticercus antibody were negative. The human immunodeficiency virus (HIV), hepatitis B surface antigen (HBsAg), and hepatitis C virus (HCV) tests were also negative with normal blood cluster of differentiation 4 (CD4) subset count. The serology for antinuclear antibody and antineutrophil autoantibodies were also negative. The blood culture was sterile and gastric aspirate did not show any acid-fast bacilli. Cerebrospinal fluid (CSF) done outside showed only two cells/mm 3 (all lymphocytes), CSF protein was 117 mg/dL, and CSF glucose was 18.2 mg/dL. A repeat CSF study showed 311 cells/mm 3 with neutrophil predominance, elevated CSF protein (298 mg/dL), and low glucose (30 mg/dL). The CSF Ziehl-Neelsen (ZN) stain was negative though the GeneXpert detected mycobacterium tuberculosis (MTB), sensitive to rifampicin. The fungal culture, India ink preparation for cryptococcus and CSF toxoplasma polymerase chain reaction (PCR) were negative.
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4364366000