Delir als primare manifestation einer tuberkulbsen meningoenzephalitis

This case report emphasizes the importance of central nervous system infections for the differential diagnosis of psychiatric symptoms. We report on a patient with progressive depressive symptoms culminating in delirium. The results of cerebrospinal fluid examination (lymphomonocytic pleocytosis with markedly increased protein and reduced glucose quotient) and magnetic resonance imaging (pronounced enhancement of the basal leptomeninges, diffuse brain oedema, and marked hydrocephalus) suggested a diagnosis of neurotuberculosis. An extensive search for an infectious agent was negative, apart from a weakly positive polymerase chain reaction indicating tuberculi in the cerebrospinal fluid. Upon treatment with combination anti-tuberculous therapy, the cerebrospinal fluid and magnetic resonance imaging abnormalities resolved and the patient's psychiatric and neurologic symptoms dissipated. The patient's clinical course and the exclusion of other etiologies support the diagnosis of tuberculous meningoencephalitis. This case report illustrates the occurrence of the often poorly described psychopathological changes as the presenting manifestations of tuberculous meningoencephalitis and the importance of initiating empiric anti-tuberculous therapy if tuberculosis is suspected, whereas cultures for tuberculosis remain negative.