Tuberculous meningitis together with systemic brucellosis

Abstract

We present a case of a 57-year-old woman admitted with findings of meningitis. Cerebrospinal fluid (CSF) tests revealed a pleocytosis together with a low CSF glucose concentration. Empirically, antituberculosis treatment was started. Rose Bengal and Wright tests were performed to exclude brucellosis with central nervous system involvement. These tests were positive in serum but not in CSF. Antibrucellosis treatment with doxycycline and ceftriaxone was started without withdrawing the antituberculosis treatment because of the possibility of simultaneous infection with both tuberculosis and brucellosis agents. Finally, this approach was shown to be correct when tuberculosis was isolated from the culture of CSF. Clinicians in endemic regions for brucellosis should be careful while diagnosing subacute/chronic meningitis. Other possible similar etiologies such as Mycobacterium tuberculosis must be ruled out before attributing the meningitis to brucellosis.