Abstract Ref Number = APCP1123
A CHILD PRESENTING WITH TUBERCULOUS MENINGITIS AND SPINAL TUBERCULOUS SPONDYLITIS
Meliana Sulistio,Annisa Muhyi
RSUD Abdul Wahab Sjahranie Samarinda
Background : Indonesia is one of highest burden of tuberculosis globally that more than 360.000 new cases found in 2016 and 25% of pediatric tuberculosis cases are extrapulmonary. Risk factors for extrapulmonary tuberculosis are poverty, malnutrition, and immunocompromised system. Tuberculous meningitis is acute inflammation of meningen, subaracnoid space, and brain vascularitation resulting the Mycobacterium tuberculosis infection. Cerebrospinal fluid (CSF) evaluation found high early lymphocytes, very high protein and low glucose level. Tuberculous spondylitis is the other case of extrapulmonary tuberculosis with local pain, tenderness, stiffness, and muscle spasm in spinal. Early diagnosis and prompt treatment are essential to prevent severe disability.
Case Presentation Summary : A ten years old boy came to Emergency Room with fever for 45 days, neurological symptoms (irritability, refusal to feed, headache), poor weight gain, and painful spine. BCG immunization in neonatal period was followed by normal reaction and scar. Contact history of tuberculosis was positive. On physical examination found severe malnutrition, neck stiffness, bulge in lumbar region, and paraparesis. Initial blood test showed hypochromic microcytic anemia (Hemoglobin 8,4 g/dL) and high sedimentation rate (18 mm/hour). CSF analysis showed muddy liquid, high polinuclear count (95%), low protein level (1,38 mg/dL), and low glucose level (9 mg/dL). Head CT scan findings were normal. Plain radiography showed destruction and collapse of T12-L1. Antitubercular medication (isoniazid, rifampicin, pyrazinamide, and ethambutol) was started empirically with high calorie and protein diet. A few days after the treatments, headache and painful spine start to decrease.
Learning Points/Discussion : The diagnosis of our patient was based on combination of clinical, laboratory, and radiological findings. The low mononuclear count with low protein level in CSF analysis doesn't rule out the diagnosis. SDGs announce that end the epidemic of tuberculosis in 2030. This target is on the track in Indonesia so high index of suspicion is needed to make an early diagnosis to reduce the complication.
Keywords: Tuberculous Meningitis Spinal Tuberculous Spondylitis Antitubercular Medication