The importance of a correct and prompt diagnostic in a case of bacillar meningo-encephalitis

Abstract

Introduction. Meningitis is the inflammation of the meninges and can be of infectious cause, the most common being viral, followed by bacterial, but which associates a more severe and rapid evolution, even when it is treated correctly and promptly. In infants and children tuberculous meningitis develops more frequently as a complication of progressive primary infection. Case presentation. A 12-year-old female patient presents to the emergency room with fronto-parietal headache, vomiting, vertigo and lumbar pain, which, despite treatment with oral cephalosporin, returns after 3 days, because the symptoms persist. She is admitted, her treatment is escalated, IV fluoroquinolones and acyclovir are added, along with corticotherapy and cerebral depletives, but within 48 hours the general condition worsens, associating severe headaches, neck stiffness and personality disturbances. Lumbar puncture detects high levels of leukocytes and proteins and low levels of glucose and chlorine, so the patient is transferred to an Intensive Care Unit, intubated and mechanically ventilated. MRI reveals meningoencephalitis with ponto-mesencephalic and cerebellar involvement, with biological minimal leukocytosis with neutrophilia and minimal inflammatory syndrome, the repeated lumbar puncture present the same pathological elements, but the PCR of CSF is positive for Mycobacterium tuberculosis and the diagnosis is of severe tuberculous meningoencephalitis. Under tuberculostatic treatment (isoniazid 5 mg/kg/day, rifampicin 10 mg/kg/day, ethambutol 20 mg/kg/day, pyrazinamide 30 mg/kg/day) associated with vitamin therapy (B1 and B6 – to prevent peripheral neuropathy induced by isoniazid), corticotherapy and cerebral depletives, after 5 days, the evolution was towards healing, which allowed extubation and later discharge, continuing the 7/7 tuberculostatic scheme for 30 days. A subsequent pulmonary assessment is necessary for conversion to 2/7 regime. Conclusions. Meningitis must be promptly and correctly diagnosed and treated, otherwise the evolution is serious, the patient may develop sequelae or even develop towards death. An important element is the anamnesis, because in the presents case, a member of the patient’s family has recently been hospitalized for a respiratory pathology for which he required oxygen therapy.