Tuberculous meningitis

Discussion:

Presentation of acute hydrocephalus and a combination of osseous, leptomeningeal and subependymal enhancing lesions.

Given the rapidity of change, appearances favor an infective process such as tuberculosis (TB), rather than metastases, lymphoma or sarcoidosis.

This patient's CSF initial gram stain and culture were negative. However, the presumed T7/T8 diskitis/osteomyelitis was biopsied under CT guidance. Although the gram stain form this biopsy was negative and there were no acid-fast bacilli identified; the subsequent PCR test and extended culture were positive for TB.

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