Diagnostic Dilemma

Tuberculous meningitis

A 4½ years old girl presented with fever for 15 days, headache for 7 days and stiffness of legs for 7 days. Patient was admitted in a hospital a week back and treated with IV Fluids and IV antibiotics. CSF done at that time showed 3,900 cells, cu mm {78 percent polymorphs, 22 percent lymphocytes}, proteins 90 mg, dl, Glucose 43 mg percent. HIV ELISA was negative. ESR was 102 mm at end of 1 hour. There is history of tuberculosis in a girl in the neighbourhood. On examination, she had neck stiffness with pain on extension of extremities. MRI spine showed an anterior epidural abscess measuring 6.5 x 1.0 cm diameter from C1 – C4 with marked enhancement of adjacent leptomeninges with bilateral basal pleural effusion with basal collapse consolidation and a large multiloculated left psoas abscess extending from L1 till mid pelvis with normal spinal cord. She was treated with 4 drug antituberculous therapy {ATT}. However she developed morbilliform rash and fever with elevated liver enzymes {SGPT = 139 IU, L, SGOT = 225 IU, L} due to ATT. She was then shifted to alternate ATT consisting of Ciprofloxacin, Ethambutol and Streptomycin and antibiotics were withheld. Her liver enzymes decreased and fever and rash subsided.

Which antituberculous agent is the likely cause_?
Expert Opinion :
All of you correctly mentioned that it may be due to anti TB drugs. INH usually causes jaundice whereas Rifampicin and PZA usually cause elevated liver enzymes. However rash is usually with rifampicin. Treatment consists of stopping all hepatotoxic drugs till liver normalizes.

Now, the question is how to reintroduce the anti TB drugs once liver enzymes normalize_? Any suggestions
Answer Discussion :
Hafiz Muhammad Akhtar
Rifampicin andisoniazid
12 years ago
Ehkcash adv
12 years ago

View More Comments

Disclaimer: The information given by www.pediatriconcall.com is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0