Affiliations: Department of Pediatrics, Shaikh Khalifa Medical City,
Abu Dhabi, United Arab Emirates
Note: [] Correspondence: Dr. Mohammad Howidi, Department of Pediatrics,
Shaikh Khalifa Medical City, P.O. Box 51900, Abu Dhabi, United Arab Emirates.
E-mail: howmoh741@skmc.gov.ae
Abstract: We report a case of tuberculous meningitis in a 3.5-year-old child
who presented with subtle symptoms. The symptoms were somnolence, low-grade
fever, and vomiting. The physical exam revealed neck stiffness and depressed
sensorioum. Encephalopathy was suspected. Lumbar puncture showed modest
pleocytosis. Cerebrospinal fluid smear for acid fast bacilli and later for
Mycobacterium tuberculosis were negative. Polymerase chain reaction (PCR) for
M. tuberculosis was positive twice, and the patient was diagnosed early in the
course of the disease, treated accordingly, and recovered completely. Our
laboratory performance consists of 36 tuberculous positive cases; 34 were PCR
positive and 246 tuberculosis negative cases; nine were PCR positive, which is
consistent with sensitivity of 94.4%, specificity of 96.3%, positive predictive
value of 79%, negative predictive value of 99%, and likelihood ratio of 25.5.
Tuberculous meningitis was diagnosed by a positive PCR whereas the smear and
the Mycobacterium culture came back were negative. PCR has proven to be quite
useful in the diagnosis of tuberculous meningitis and was life saving on our
child in the case of this patient.
