ABSTRACT
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.
Subject(s)
Humans , Male , Adolescent , Arthritis, Juvenile/complications , Arthritis, Juvenile/drug therapy , Tuberculosis, Meningeal/diagnosis , Tuberculosis, Meningeal/etiology , Tumor Necrosis Factor Inhibitors , Antitubercular Agents/adverse effects , Tuberculosis, Meningeal/cerebrospinal fluid , Magnetic Resonance Imaging , Polymerase Chain Reaction , Fatal Outcome , Mycobacterium tuberculosis/isolation & purificationABSTRACT
Brevibacterium spp. are catalase-positive, non-spore-forming, non motile, aerobic Gram- positive rods that were considered apathogenic until a few reports of infections in immunocompromised patients had been published. To the best of our knowledge, this is the first report of B. casei catheter-related bloodstream infection in a child with acute leukemia. We aim to enhance the awareness of pediatric hematology and infectious disease specialists about this pathogen and review of the literature.