A fatal case of tuberculous meningitis in a child with juvenile idiopathic arthritis: a diagnostic challenge

Abstract The prognosis of tuberculous meningitis, a rare form of extrapulmonary tuberculosis, depends on the stage of treatment initiation. We report a fatal case of tuberculous meningitis. The patient had received successive tumor necrosis factor (TNF) antagonists and abatacept to treat juvenile idiopathic arthritis, with negative results for polymerase chain reaction and acid-fast bacilli on smear, had normal cerebrospinal fluid (CSF) adenosine deaminase and glucose levels. Six weeks post-admission, the CSF culture demonstrated Mycobacterium tuberculosis. The altered immunological responses caused by anti-TNF treatment made the diagnosis challenging. Clinicians should bear this in mind and, if suspected, treatment should be initiated immediately.

摘要 结核性脑膜炎是一种少见的肺外结核亚型，其预后取决于治疗启动的时机。本文报告1例致死性结核性脑膜炎病例。该患者曾先后接受肿瘤坏死因子（TNF）拮抗剂与阿巴西普治疗幼年特发性关节炎，其聚合酶链反应（PCR）与抗酸杆菌涂片检测结果均为阴性，脑脊液（CSF）腺苷脱氨酶及葡萄糖水平均处于正常范围。入院6周后，脑脊液培养检出结核分枝杆菌。抗TNF治疗引发的免疫应答改变给诊断带来了挑战。临床医师应警惕此类情况，若怀疑本病应立即启动治疗。