Obara Kazuki, Tsuboi Takashi, Mori Yu, Sanda Akihiro, Mouri Naohiro, Takagi Shinnosuke, Aoki Shinichiro, Katsuno Masahisa
Department of Neurology, Gifu Prefectural Tajimi Hospital, Japan.
Department of Neurology, Nagoya University Graduate School of Medicine, Japan.
Intern Med. 2025 Mar 15;64(6):931-936. doi: 10.2169/internalmedicine.4087-24. Epub 2024 Aug 10.
Managing tuberculous meningitis (TBM) is challenging because of its poor prognosis and the difficulty in making an early diagnosis due to the low sensitivity of cerebrospinal fluid (CSF) polymerase chain reaction (PCR) evaluations. A 75-year-old woman presented with fatigue and multiple enlarged lymph nodes and was initially suspected of having metastatic cancer of unknown primary origin. Differential diagnoses included carcinomatous meningitis, neurosarcoidosis, and TBM, as suggested by the presence of multiple enhancing cerebral nodules. Despite 11 negative PCR evaluations, including nested PCR of CSF and biopsied lymph nodes within the first 3 days of empirical anti-tubercular treatment, TBM was eventually confirmed by CSF cultures 32 days later. This case highlights the need for repeated sampling.
由于结核性脑膜炎（TBM）预后较差，且脑脊液（CSF）聚合酶链反应（PCR）检测灵敏度低，早期诊断困难，因此其治疗颇具挑战性。一名75岁女性出现疲劳和多处淋巴结肿大，最初怀疑患有原发灶不明的转移性癌症。鉴别诊断包括癌性脑膜炎、神经结节病和TBM，多个强化脑结节提示了这些可能。尽管在经验性抗结核治疗的前3天进行了11次PCR检测均为阴性，包括脑脊液和活检淋巴结的巢式PCR，但32天后脑脊液培养最终确诊为TBM。该病例凸显了重复采样的必要性。
