Tuberculous meningitis in an intravenous drug user: A case report

Year 2024, , 117 - 119, 30.10.2024

Haticenur Yıldırım , Baycan Kus , Gözde Yılmaz , Necmi Baykan , Ömer Salt

https://doi.org/10.61845/agrimedical.1457721

Abstract

Tubercle bacilli can cause tuberculous meningitis by hematogenous spread from a primary focus.
A 49-year-old foreign national male patient was admitted to the emergency department with complaints of joint pains, fever, cough and malaise. He was diagnosed with a viral upper respiratory tract infection and discharged after treatment was organised. The patient was admitted again the next day with the complaint of inability to urinate, and suprapubic tenderness was also present on physical examination. The patient's laboratory values, different from the previous day, were determined as WBC:16000/µL CRP:115 mg/L, and he was discharged again after oral treatment. On his 3rd admission to the emergency department, he had complaints of weakness and numbness in the legs and spasm in the neck. It was learned that the patient had a history of intravenous substance use. Following the tests, the patient was initially diagnosed with atypical meningitis and was taken to the intensive care unit. As a result of advanced examinations performed here, the patient was diagnosed with tuberculous meningitis and treated.
Patients who experience repeated hospitalisations and exhibit abnormal neurological symptoms should have a thorough physical examination, deeper anamnesis, and considered in the diagnosis that takes uncommon illnesses like atypical meningitis into account.

Keywords

Tuberculous meningitis, Double application, Emergency department

Damar içi madde kullanan bir hastada tüberküloz menenjiti: Olgu sunumu

Abstract

Tüberküloz basili, primer bir odaktan hematojen yayılım yoluyla tüberküloz menenjite neden olabilir.
49 yaşında yabancı uyruklu erkek hasta eklem ağrıları, ateş, öksürük ve halsizlik şikayetleri ile acil servise başvurdu. Hastaya viral üst solunum yolu enfeksiyonu tanısı konmuş ve tedavisi düzenlendikten sonra taburcu edilmiştir. Hasta ertesi gün idrar yapamama şikayeti ile tekrar başvurdu ve fizik muayenede suprapubik hassasiyet de mevcuttu. Hastanın laboratuvar değerleri bir önceki günden farklı olarak WBC:16000/µL CRP:115 mg/L olarak belirlendi ve oral tedavi sonrası tekrar taburcu edildi. Acil servise 3. başvurusunda bacaklarda güçsüzlük ve uyuşma, boyunda spazm şikayetleri vardı. Hastanın intravenöz madde kullanım öyküsü olduğu öğrenildi. Yapılan tetkiklerin ardından hastaya ilk olarak atipik menenjit tanısı konuldu ve yoğun bakım ünitesine alındı. Burada yapılan ileri tetkikler sonucunda hastaya tüberküloz menenjit tanısı konularak tedavi altına alındı.
Tekrarlayan hastane yatışları yaşayan ve anormal nörolojik semptomlar sergileyen hastalar kapsamlı bir fizik muayene, daha derin bir anamnez ve atipik menenjit gibi nadir görülen hastalıkları dikkate alan bir tanıya tabi tutulmalıdır.

Keywords

Tüberküloz menenjiti, Mükerrer başvuru, Acil servis

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