Tuberculous meningitis diagnosed on repeat cerebrospinal fluid analysis after unremarkable initial findings: a case report

Tuberculous meningitis (TBM) is a severe and often fatal form of extrapulmonary tuberculosis.We describe a case in which the initial cerebrospinal fluid (CSF) analysis showed no specific abnormalities, but a diagnosis was established after repeat CSF evaluation.A 41-year-old female presented with a 10-day history of persistent fever and headache.Initial CSF analysis demonstrated an opening pressure of 150 mmH 2 O, a white blood cell (WBC) count of 10/µL, a glucose level of 50 mg/dL, and a protein level of 31.4 mg/dL.Despite treatment with an antiviral agent and doxycycline, her symptoms did not improve.A repeat CSF analysis demonstrated an opening pressure of 120 mmH 2 O, an elevated WBC count of 140/µL (55% lymphocytes), a glucose level of 52 mg/dL, and an elevated protein level of 201.6 mg/dL, which was highly suggestive of TBM.This case highlights the importance of repeat CSF analysis based on clinical judgment when diagnosing TBM.