Autoimmune glial fibrillar acidic protein astrocytopathy mimicking tuberculous meningitis

Abstract

Autoimmune glial fibrillar acidic protein (GFAP) astrocytopathy typically presents as acute or subacute meningoencephalitis with or without myelitis. We describe a case of autoimmune GFAP astrocytopathy that mimicked tuberculous meningitis. A man in his 70s was referred to our hospital with lethargy persistent for 2 months, appetite loss for 1 month and fever with headache for 10 days. The cerebrospinal fluid test revealed lymphocytic pleocytosis with elevated adenosine deaminase (ADA). Laboratory investigations ruled out microbial and neoplastic causes. Empirical therapy for tuberculous meningitis combined with corticosteroid improved the patient’s condition. Culture forMycobacterium tuberculosisfailed to show microbial growth despite 1 month of incubation. The cerebrospinal fluid was examined for GFAP antibody and returned positive result. Antituberculous agents were discontinued, and corticosteroid was administered until patient’s symptoms resolved completely. Thus, clinicians should consider autoimmune GFAP astrocytopathy as one of the differential diagnoses of lymphocytic meningitis with elevated ADA.

Lemierre syndrome with pulmonary empyema caused byPrevotella intermedia

“…Internal jugular thrombophlebitis is often unilateral, but bilateral involvement has also been described16 and pulmonary complications are attributed to septic emboli. Lemierre syndrome is most commonly caused by F. necrophorum , an obligate anaerobic gram-negative bacillus that is part of the normal flora of oral cavity, gastrointestinal and female genital tract.…”

Autoimmune glial fibrillary acidic protein astrocytosis mimicking tuberculous meningitis: a retrospective study

“…Elevated CSF lymphocytes, protein is more common in TBM; autoimmune disease is uncommon. Studies have revealed that the cerebrospinal fluid of A-GFAP-A patients is predominantly characterized by inflammatory changes and that CSF lymphocytes and proteins can be increased, with some patients exhibiting CSF protein > 1.0 g/L [2,[4][5][6][8][9][10]. A CSF protein threshold of > 1.0 g/L (100 mg/dL) differentiated between cases of TBM, bacterial meningitis [17], and viral meningitis [18].…”

“…Clinical symptoms include fever, headache, brain and meningeal abnormalities, imaging and cerebrospinal fluid changes, lack of specificity, and susceptibility to misdiagnosis. Especially when the cerebrospinal fluid depicts tuberculous lesions, it is easily confused with tuberculous meningitis (TBM) [3][4][5][6][7][8][9]. This study retrospectively examined the clinical features of A-GFAP-A in patients with tuberculous meningitis to improve understanding and diagnostic efficacy.…”

Infections caused by Slackia exigua: A single-center experience and literature review

“…W piśmiennictwie coraz częściej opisywane są zakażenia zlokalizowane poza jamą ustną. Gatunek ten wyizolowano z próbek pobranych w przebiegu zakażenia okołoprotezowego stawów (12,18), zakażeń ran, ropni (13,19), ciężkiego ropniaka z zespołem ostrej niewydolności oddechowej (20), bakteriemii (21)(22)(23) i zapalenia opon mózgowo-rdzeniowych (24,25).…”

“…More reports of S. exigua extra-oral infections are being published. This species has been isolated from periprosthetic joint infections (12,18), human wound infections, abscesses (3,19), severe empyema with acute respiratory distress syndrome (20), bacteremia (21)(22)(23), and meningitis (24,25).…”