Clinical Report: Concurrent Tuberculous Meningoencephalitis and Autoimmune GFAP Astrocytopathy
Background
Tuberculous meningoencephalitis is a severe CNS infection caused by Mycobacterium tuberculosis, often leading to high mortality and disability if untreated. Autoimmune GFAP astrocytopathy is an inflammatory condition characterized by the presence of GFAP antibodies, complicating the diagnosis of CNS disorders. The overlap of these two conditions can lead to misdiagnosis and challenges in management.
Data Highlights
The patient presented with fever, cognitive slowing, and limb weakness. CSF analysis revealed pleocytosis, increased protein, decreased glucose, and decreased chloride levels. MRI showed multiple parenchymal signal abnormalities and leptomeningeal enhancement.
Key Findings
Concurrent tuberculous meningoencephalitis and GFAP astrocytopathy is a rare overlap syndrome.
CSF analysis showed pleocytosis and abnormal biochemical markers indicative of both conditions.
Positive GeneXpert MTB/RIF confirmed the diagnosis of tuberculous meningoencephalitis.
GFAP antibodies were detected in both serum and CSF.
Clinical improvement was noted after treatment with antitubercular drugs and corticosteroids.
Imaging studies demonstrated paradoxical worsening of lesions after steroid tapering.
Clinical Implications
Clinicians should consider the possibility of concurrent tuberculous meningoencephalitis and GFAP astrocytopathy in patients presenting with overlapping symptoms. Careful monitoring of treatment response and imaging findings is essential to manage potential paradoxical reactions effectively.
Conclusion
This case underscores the complexity of diagnosing and treating overlapping CNS conditions, emphasizing the importance of a comprehensive approach to patient management.
