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Pain Management 2018
Internal Medicine 2018
International Journal of Anesthesiology & Pain Medicine
ISSN: 2471-982X
Page 56
March 26-28, 2018
Vienna, Austria
JOINT EVENT
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E d i t i o n o f I n t e r n a t i o n a l C o n f e r e n c e o n
Internal Medicine and Patient Care
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E d i t i o n o f I n t e r n a t i o n a l C o n f e r e n c e o n
Pain Management
Volume 4
Background:
DiagnosingCNS tuberculosis is challengingbecause
of its rarity, indolent course, and insensitive microbiological
diagnosis. Early (often empirical) initiation of treatment is
important.
Case report:
A 36-year-old male from Pakistan with no past
medical history was brought to the hospital with fever (39℃)
and altered behavior since 2 weeks. He was malnourished,
confused, with nuchal rigidity, an enlarged right cervical lymph
node and swelling of the left knee and ankle. Lab test showed
low inflammatory markers and lymphocytopenia. The first head
CT was normal. Lumbar puncture revealed 500 leucocytes
(83% lymphocytes), protein 314 mg/dL and glucose 32 mg/
dL. He was started on ceftriaxone, ampicillin and acyclovir
pending further cerebrospinal fluid (CSF) analysis. CSF acid-fast
staining, tuberculin skin test, CSF PCR for MTB, testing for HIV,
Cryptococcus (India ink staining and cryptococcal antigen in CSF)
and syphilis were all negative. Due to the patient’s worsening
neurological status, an MRI was performed revealing worsening
hydrocephalus. A ventriculostomy was placed and he was started
on anti-tuberculosis therapy (isoniazid, pyrazinamide, rifampicin,
moxifloxacin) and adjunctive prednisone. Other imaging findings
consistent with tuberculous encephalitis were also noted:
cerebral edema, leptomeningeal enhancement, and infarction of
the basal ganglia. A chest CT showed bilateral upper pulmonary
fibrosis and nodules. Gastric and bronchial aspirates were
obtained and were positive (PCR and culture) for MTB. Synovial
fluid analysis revealed 30 leukocytes/ul with negative cultures
(suggesting Poncet’s disease). Despite improvement of the level
of conscience, neurological improvement was otherwise limited
and the patient died 4 months later, after repeated in-hospital
infections.
Biography
Stamatis Karakonstantis is a resident of Internal Medicine. He graduated
from the Medical Faculty of the University of Crete, in Heraklion and com-
pleted an MRes degree from the University of Birmingham. He is a new au-
thor and has so far published 8 manuscripts.
stamkar2003@gmail.comDisseminated Mycobacterium tuberculosis (MTB) infection
with central nervous system (CNS) involvement and
Poncet’s disease
Stamatis Karakonstantis, Sofia Pitsigavdaki, Dafni Korela, Athina Savva, Eugenia
Emmanouilidou, Despina Galani, Melina Kavousanaki
and
Thalassinos Evangelos
General Hospital of Heraklion “Venizeleio-Pananeio”, Greece
Stamatis Karakonstantis et al., Int J Anesth Pain Med 2018, Volume 4
DOI: 10.21767/2471-982X-C1-003