Delayed diagnosis of tuberculous meningitis in a pregnant Nigerian: A case report
Delayed diagnosis of tuberculous meningitis in a pregnant Nigerian: A case report
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DOI：
10.1016/j.ijmyco.2013.01.003
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发表时间：
2013-03-01
影响因子：
1.2
通讯作者：
Bemgba, Achie Basil
中科院分区：
文献类型：
--
作者：
Ejiji, Isa Samson;Gomerep, Simji;Bemgba, Achie Basil
结核性脑膜炎(TBM)是最严重的结核病形式，在那些免疫抑制的人中更常见。诊断仍然很困难，特别是在资源有限的情况下，在怀孕情况下可能更是如此。我们报告一位怀孕的奈及利亚人，诊断较晚，有不典型的特发性脑脊髓炎合并脑梗塞。高可疑指数和根据国家治疗指南早期应用抗结核药物作为每日治疗：利福平600 mg，异烟肼300 mg，吡嗪酰胺1.2g，乙胺丁醇800 mg，吡哆醇50 mg，地塞米松0.4 mg/kg体重/天，每周逐步减少，导致临床改善缓慢但持续。妊娠与TBM易感性及临床表现之间的关系有待进一步探讨。临床医生也应该意识到妊娠期结核的非典型表现，怀疑结核可能是启动经验性抗结核治疗的充分理由。(C)2013年亚非分枝杆菌学会。版权所有。
Tuberculous meningitis (TBM) is the most severe form of tuberculosis and is commoner in those with immunsuppression. Diagnosis continues to be difficult particularly in resource limited settings, and this may be truer in the setting of pregnancy. We report the case of a pregnant Nigerian who was diagnosed late with atypical features of TBM complicated by cerebral infarction. High index of suspicion and early administration of anti-tuberculous medications as daily therapy according to the national treatment guidelines: 600 mg Rifampicin, 300 mg Isoniazid, 1.2 g Pyrazinamide and 800 mg Ethambutol plus 50 mg pyridoxine and 0.4 mg/kg body weight/day dexamethasone which was tapered weekly led to a slow but sustained clinical improvement. The relationship between pregnancy, susceptibility to TBM and presenting features of TBM requires further exploration. Clinicians should also be aware of atypical presentation of TBM in pregnancy, and the suspicion of TBM may be sufficient grounds to initiate empirical anti-tuberculous therapy. (C) 2013 Asian-African Society for Mycobacteriology. All rights reserved.