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CASE REPORT
Severe hyponatremia and MRI point to diagnosis of tuberculous meningitis in the Southwest USA
  1. Stephanie Michelle Benson1,2,
  2. Rashmi Narasimhamurthy1
  1. 1Department of Family Medicine, Southern New Mexico Family Medicine Residency Program, Las Cruces, New Mexico, USA
  2. 2Department of Family Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
  1. Correspondence to Dr Stephanie Michelle Benson, stephanie.benson{at}lpnt.net

Summary

A 21-year-old woman presented to the hospital with 3 days of headache, fever, mood disturbance and nausea. She had recently emigrated from India, and was noted to have a positive screening purified protein derivative  tuberculosis  skin test with normal chest x-ray. Meningeal signs were noted prompting lumbar puncture and initiation of presumptive treatment for bacterial meningitis. While tuberculous meningitis (TM) was entertained at admission, diagnosis was clouded by the rapid onset of symptoms and recent major psychosocial stressors. She developed severe hyponatremia. Brain MRI revealed tuberculomas, and she was started on treatment for TM, a diagnosis confirmed by culture. On review, several lessons were learned: (1) globalisation of society makes uncommon diagnoses present in unlikely locations, (2) hyponatremia is a common complication of TM, (3) MRI can aid in diagnosis of TM and (4) cognitive and mood changes can be prodromal symptoms of TM.

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