Article in Japanese

Successful treatment of a pediatric case of tuberculosis meningitis without Mycobacterium tuberculosis detection

Takanari ABEMATSU¹⁾, Shinsuke MARUYAMA¹⁾, Yumi OGAWA¹⁾, Shinji ARATAKE²⁾, Koichi TOKUDA³⁾, Junichiro NISHI⁴⁾, Yoshifumi KAWANO¹⁾

A 17-month-old girl had had grizzle, anorexia, and low-grade fever since 14 months of age. She had convulsive seizures at the age of 15 and 17 months. As magnetic resonance imaging (MRI) revealed enhancement of the cerebral base and hydrocephalus, urgent ventricular drainage and biopsy of the lateral ventricle were performed. Cerebrospinal fluid (CSF) analysis revealed a white blood cell count of 236/μl with lymphocyte dominancy. Her glucose and protein level was 23 mg/dl and 817 mg/dl, respectively. No significant sign was detected on chest radiography or computed tomography. Pathological examination revealed a number of remarkable epithelioid, multinucleated giant, and chronic inflammatory cells. A smear, culture or nucleic acid amplification test could not detect Mycobacterium tuberculosis. The level of adenosine deaminase (ADA) in CSF, which reportedly has high specificity, was elevated to 40 U/l. This study strongly suspected tuberculous meningitis and antituberculous therapy was started, including isoniazid, rifampicin, pyrazinamide and ethambutol. After initiating the therapy, the patient's appetite and general condition immediately improved. CSF findings, including ADA level, were normalized immediately. Contrast MRI findings also improved. Comprehensive diagnosis based on MRI findings and ADA level is important, as well as prompt initiation of treatment for tuberculous meningitis, even if no M. tuberculosis has been detected.

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1) Department of Pediatrics, Kagoshima University Hospital
2) Department of Pediatrics, Ibusuki Medical Center
3) Department of Infection Control, Kagoshima University Hospital
4) Department of Microbiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima University

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Received	November 10, 2016
Accepted	February 2, 2017

29 (1)：49─54,2017