International Journal of Anesthesiology & Pain Medicine

Disseminated Mycobacterium tuberculosis (MTB) infection with central nervous system (CNS) involvement and Poncet’s disease

Joint Event on 7^th Edition of International Conference on Internal Medicine and Patient Care & 6^th Edition of International Conference on Pain Management
March 26-28, 2018 Vienna, Austria

Stamatis Karakonstantis, Sofia Pitsigavdaki, Dafni Korela, Athina Savva, Eugenia Emmanouilidou, Despina Galani, Melina Kavousanaki and Thalassinos Evangelos

General Hospital of Heraklion â�?�?Venizeleio-Pananeioâ�?, Greece

Posters & Accepted Abstracts: Int J Anesth Pain Med

DOI: 10.21767/2471-982X-C1-003

Abstract

Background: Diagnosing CNS tuberculosis is challenging because of its rarity, indolent course, and insensitive microbiological diagnosis. Early (often empirical) initiation of treatment is important. Case report: A 36-year-old male from Pakistan with no past medical history was brought to the hospital with fever (39��?) and altered behavior since 2 weeks. He was malnourished, confused, with nuchal rigidity, an enlarged right cervical lymph node and swelling of the left knee and ankle. Lab test showed low inflammatory markers and lymphocytopenia. The first head CT was normal. Lumbar puncture revealed 500 leucocytes (83% lymphocytes), protein 314 mg/dL and glucose 32 mg/ dL. He was started on ceftriaxone, ampicillin and acyclovir pending further cerebrospinal fluid (CSF) analysis. CSF acid-fast staining, tuberculin skin test, CSF PCR for MTB, testing for HIV, Cryptococcus (India ink staining and cryptococcal antigen in CSF) and syphilis were all negative. Due to the patient��?s worsening neurological status, an MRI was performed revealing worsening hydrocephalus. A ventriculostomy was placed and he was started on anti-tuberculosis therapy (isoniazid, pyrazinamide, rifampicin, moxifloxacin) and adjunctive prednisone. Other imaging findings consistent with tuberculous encephalitis were also noted: cerebral edema, leptomeningeal enhancement, and infarction of the basal ganglia. A chest CT showed bilateral upper pulmonary fibrosis and nodules. Gastric and bronchial aspirates were obtained and were positive (PCR and culture) for MTB. Synovial fluid analysis revealed 30 leukocytes/ul with negative cultures (suggesting Poncet��?s disease). Despite improvement of the level of conscience, neurological improvement was otherwise limited and the patient died 4 months later, after repeated in-hospital infections.

Biography

Stamatis Karakonstantis is a resident of Internal Medicine. He graduated from the Medical Faculty of the University of Crete, in Heraklion and completed an MRes degree from the University of Birmingham. He is a new author and has so far published 8 manuscripts.

Email:stamkar2003@gmail.com