Optic disc swelling in a patient with tuberculous meningitis: a diagnostic challenge

BMJ Case Rep. 2017 Aug 9;2017:bcr2017221170. doi: 10.1136/bcr-2017-221170.

Abstract

We discuss the diagnostic challenge in an adult patient presented with purely ocular symptoms diagnosed with tuberculous meningitis (TBM). A 38-year-old woman presented with bilateral painless blurring of vision. There were bilateral sixth cranial nerve palsy and bilateral optic disc swelling. Optic nerve function tests were normal. Patient was lucid with no signs of meningism. Brain imaging were normal. She had a positive Mantoux test, high erythrocyte sedimentation rate but no clinical evidence of active pulmonary tuberculosis infection. Her Quantiferon-TB Gold in-tube test was negative. Cerebrospinal fluid analysis revealed a high opening pressure but no biochemical parameters to suggest TBM, hence she was treated as idiopathic intracranial hypertension. A diagnosis of TBM was finally made following a positive PCR for Mycobacterium tuberculosis Her vision improved with reduction in optic disc swelling following antituberculous treatment.

Keywords: meningitis; neuroophthalmology; tuberculosis.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antitubercular Agents / administration & dosage
  • Antitubercular Agents / therapeutic use
  • Diagnosis, Differential
  • Drug Administration Schedule
  • Female
  • Humans
  • Papilledema / drug therapy
  • Tuberculosis, Meningeal / complications
  • Tuberculosis, Meningeal / diagnosis*
  • Tuberculosis, Meningeal / diagnostic imaging
  • Tuberculosis, Meningeal / drug therapy
  • Vision Disorders / etiology

Substances

  • Antitubercular Agents