Concluded Case

52yrs old female presented with repeated attacks of fever through months associated with nausea and vomittings.Loss of weight and appetite since 2mnths. N/h/o Seizures or chest problem,There was no family history of TB.Fundus normal O/e - Conscious, disoriented, exhausted.Pupils - B/l 4mm RTL,No meningeal signs present, Cerebellar signs negative,Plantars bilateral extensors.quadriparesis with a power 4/5 in all four limbs, tremors, dysarthria, dysmetria.Sputum examination for AFB could not be done as a patient had no cough.Mantoux test was positive,PCR test positive for MTB. DIAGNOSIS AND SUGGEST TREATMENT WITH FURTHER INVESTIGATIONS PLAN??

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Concluded answer

Chronic meningitis with encephalitis due to multiple granulomas Although tb pcr was positive still evaluate for other source of tb like pulmonary or abdominal High possibility of dissemination. Csf finding should be there with basics reports, as some time pcr positivity can be due to lab contamination Get gene xpert and culture for any resistance pattern 2nd must rule out other causes like fungal like cryptococcal, ncc, and must evaluate for immunocompromised status, dm, etc HRZS with steroids as per weight

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Chronic meningitis with encephalitis due to multiple granulomas Although tb pcr was positive still evaluate for other source of tb like pulmonary or abdominal High possibility of dissemination. Csf finding should be there with basics reports, as some time pcr positivity can be due to lab contamination Get gene xpert and culture for any resistance pattern 2nd must rule out other causes like fungal like cryptococcal, ncc, and must evaluate for immunocompromised status, dm, etc HRZS with steroids as per weight

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Typical basal meningitis of tuberculosis.. Looks aggressive disease..so Needs aggressive att and AED therapy

Tuberculous meningitis? DST should be done to rule out MDR or XDR. initially treated as Category 1 patient.

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Multiple Granuloma followed by chronic encephalitis would suggest CSF analysis as well..

Suspected Tuberculer maningitis Send. Csf r/m Ada gram stain gene expert for rule out tuberculosis. Along with MP/Typhi.dot

Meningitis with granuloma

Tuberculous meningitis.treatment will consist of AKT &steroids

Tuberculosis

DX. Tuberculosis

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