Rahim Mohd Jazman Che, Ghazali Wan Syamimee Wan
Department of Internal Medicine, Hospital Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.
BMJ Case Rep. 2016 Mar 11;2016:bcr2015213171. doi: 10.1136/bcr-2015-213171.
We report a case of a 19-year-old immunocompetent Malay woman who presented with a worsening psychotic disorder of 1-year duration. She initially presented with social isolation with subsequent mutism and stupor. Physical examination revealed a stuporous, emaciated, dehydrated woman with Glasgow Coma Scale of 11/15 (E4V2M5). She had a blank stare, mutism and akinesia. Motor examination revealed upper motor neuron findings. Neck stiffness was present, however, Kernig's and Brudzinski's signs were negative. There were no other findings on other systems. Brain imaging and EEG were normal. Cerebrospinal fluid investigations revealed positive cerebrospinal fluid Mycobacterium tuberculosis PCR (MTB PCR). The patient was treated with empirical antituberculosis drugs and steroids. On follow-up visit 1 month later, her psychotic symptoms had fully resolved. She was able to ambulate and care for herself; she was unable to recall the symptoms she had experienced before and during admission.
我们报告一例19岁免疫功能正常的马来族女性病例，该患者出现持续1年的病情恶化的精神障碍。她最初表现为社交隔离，随后出现缄默和木僵。体格检查发现一名木僵、消瘦、脱水的女性，格拉斯哥昏迷量表评分为11/15（E4V2M5）。她目光呆滞、缄默不语且运动不能。运动检查显示上运动神经元体征。存在颈部强直，但克尼格征和布鲁津斯基征均为阴性。其他系统未发现其他异常。脑部影像学检查和脑电图均正常。脑脊液检查显示脑脊液结核分枝杆菌聚合酶链反应（MTB PCR）呈阳性。该患者接受了经验性抗结核药物和类固醇治疗。1个月后的随访中，她的精神症状已完全缓解。她能够行走并自理；她无法回忆起入院前及住院期间所经历的症状。
