Analysis of clinical misdiagnosis of tuberculous meningitis

LYU Zhichao; MENG yuanyuan

doi:10.3969/j.issn.1002-3429.2025.16.002

Abstract：Objective To analyze the causes of clinical misdiagnosis of tuberculous meningitis and to correct the methods of misdiagnosis.Methods The clinical data of 2 patients with tuberculous meningitis initially diagnosed as acute bronchitis and multiple lacunar cerebral infarction respectively from March to October 2022 were retrospectively analyzed.Results One patient was admitted due to intermittent fever for 10 d.Chest CT showed lung texture thickening,and the initial diagnosis was acute bronchitis.The patient was discharged after 7 d of anti-infective treatment.About 10 d later,fever recurred,and the diagnosis was not clear after repeated visits to doctors.Then,vomiting and lethargy occurred.On re-admission,lumbar puncture showed high cerebrospinal fluid pressure and high protein content,and the patient was diagnosed with tuberculous meningitis.The duration of misdiagnosis was 65 d.After anti-tuberculosis treatment,the body temperature gradually returned to normal.Three months afterwards,the patient was discharged with stable condition,and the anti-tuberculosis treatment was continued for 2 years,and medication was stopped.The patient's condition has been stable since observation.One patient was admitted due to recurrent dizziness for 20 d,which was aggravated with vomiting for 3 d.She was diagnosed as multiple lacunar cerebral infarction by head MRI examination,and symptomatic treatment was ineffective.After admission,physical examination showed ataxia and Gordon's sign that was positive.The diagnosis was benign paroxysmal vertigo,and there was no improvement after reduction treatment.Afterwards,he developed convulsions,disturbance of consciousness,and positive neck resistance.Cerebrospinal fluid examination showed increased protein,decreased glucose,and positive acid-fast staining.Tuberculous meningitis was diagnosed,and the misdiagnosis lasted 20 d.After anti-tuberculosis and glucocorticoid treatment,the symptoms were relieved.After 2 years of treatment,there was no recurrence.Conclusion The clinical symptoms of some patients with tuberculous meningitis are atypical,which is more likely to be misdiagnosed.Clinical diagnosis accuracy should be enhanced to avoid misdiagnosis and ensure timely and effective treatment for patients.