Neuro-Behcet's Syndrome with Miliary Tuberculosis Presenting with Features Mimicking Acute Tuberculous Meningitis
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A 14-year-old girl diagnosed with Behcet's disease 15 months previously presented at the emergency department with severe headache, fever, and vomiting. Chest radiographic and computed tomography findings were consistent with miliary tuberculosis, and pleocytosis and increased protein levels were found on examination of cerebrospinal fluid (CSF). Tuberculous meningitis associated with miliary pulmonary tuberculosis was suspected, and a four-drug regimen for tuberculosis plus intravenous dexamethasone was initiated. However, negative results of real-time polymerase chain reaction and CSF cultures led us to reconsider our initial diagnosis. On brain magnetic resonance imaging, the results supported neuro-Behcet's syndrome rather than tuberculous meningitis. However, it is unclear how miliary tuberculosis complicated neuro-Behcet's syndrome because the patient had no history of tuberculosis or contact with patients with tuberculosis, and had not used any immunosuppressive agents such as anti-tumor necrosis factor-alpha drugs. This is a very rare case of neuro-Behcet's syndrome associated with miliary tuberculosis. More commonly, cases of neuro-Behcet's syndrome presenting with features mimicking acute tuberculous meningitis have been reported. NeuroBehcet's syndrome should be considered in patients with a history of Behcet's disease presenting with signs of meningeal irritation.
Abstract
A 14-year-old girl diagnosed with Behcet's disease 15 months previously presented at the emergency department with severe headache, fever, and vomiting. Chest radiographic and computed tomography findings were consistent with miliary tuberculosis, and pleocytosis and increased protein levels were found on examination of cerebrospinal fluid (CSF). Tuberculous meningitis associated with miliary pulmonary tuberculosis was suspected, and a four-drug regimen for tuberculosis plus intravenous dexamethasone was initiated. However, negative results of real-time polymerase chain reaction and CSF cultures led us to reconsider our initial diagnosis. On brain magnetic resonance imaging, the results supported neuro-Behcet's syndrome rather than tuberculous meningitis. However, it is unclear how miliary tuberculosis complicated neuro-Behcet's syndrome because the patient had no history of tuberculosis or contact with patients with tuberculosis, and had not used any immunosuppressive agents such as anti-tumor necrosis factor-alpha drugs. This is a very rare case of neuro-Behcet's syndrome associated with miliary tuberculosis. More commonly, cases of neuro-Behcet's syndrome presenting with features mimicking acute tuberculous meningitis have been reported. NeuroBehcet's syndrome should be considered in patients with a history of Behcet's disease presenting with signs of meningeal irritation.
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