Prolonged Corticosteroid Use in the Treatment of Tuberculous Meningoencephalitis: A Case Report

Annija Holstroma (Corresponding Author), Arturs Balodis, Artis Brokāns, Anda Vīksna

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Abstract

Tuberculous meningoencephalitis is a rare manifestation of Mycobacterium tuberculosis (Mtb), with the most severe form and highest mortality. It can cause multiple complications, and treatment is difficult, as drugs cannot properly diffuse through the haemato-encephalitic barrier. We reported the case of a 17-year-old female patient who was admitted to the emergency room department with a fever for previous two weeks (up to 39 °C), dizziness, difficulty walking, and weight loss. Magnetic resonance imaging indicated possible meningoencephalitis, and a CT scan of the lungs visualised miliary infiltrates in both lungs. After repeated tests, Mtb DNA was found in the bronchial wash, cerebrospinal fluid, faeces, and urine via an Xpert/Rif Ultra test. Treatment was started with isoniazid, rifampicin, ethambutol, pyrazinamide, and corticosteroids as well. Although treatment was initiated within the first few days in the hospital, a reduction in glucocorticoid dosage worsened the patient’s neurological state, making treatment even more challenging. Prolonged use of glucocorticoids led to an improvement in the stage of the condition. Further, over time, the patient’s condition improved. Pulmonary infiltrations were not found after 2.5 months of starting therapy. Conclusions: Timely treatment is crucial for improving the prognosis of patients with miliary tuberculosis and tuberculous meningoencephalitis. Prompt recognition of symptoms and accurate diagnosis are essential to initiate effective treatment strategies. In this patient’s case, prolonged use of corticosteroids reduced neurologic complications, and ongoing treatment gradually improved the patient’s condition.
Original languageEnglish
Article number214
Pages (from-to)1-10
Number of pages10
JournalMedicina (Kaunas)
Volume61
Issue number2
DOIs
Publication statusPublished - 25 Jan 2025

Keywords*

  • central nervous system
  • tuberculous meningoencephalitis
  • tuberculosis

Field of Science*

  • 3.2 Clinical medicine

Publication Type*

  • 1.4. Reviewed scientific article published in Latvia or abroad in a scientific journal with an editorial board (including university editions)

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