Chronic Neutrophilic Meningitis in Tuberculous Infection: A Rare Case Presentation and review of the literature

Abstract

Persistent neutrophilic pleocytosis syndrome is a rare form of tuberculous meningitis that is defined as the persistence of neutrophils in cerebrospinal fluid for more than 7 days, in association with the clinical features of meningitis (headache, fever, and positive meningeal signs).¹ The exact pathogenesis of this syndrome is not well known yet, and it has many diverse etiologies, including infectious and noninfectious ones. among infectious ones: bacteria such as Nocardia and Actinomyces, and systemic mycoses such as Aspergillus and the zygomycetes, as well as mycobacterium.² This entity is very rare in immunocompetent patients, and most of the cases are due to infectious causes in those who are immunocompromised. The usual scenario in such cases is initiating broad-spectrum antimicrobial agents without any improvement, therefore the diagnosis is difficult initially and often delayed. Therefore, the epidemiologic features and clinical profile may offer clues to the etiologic agent, especially in the immunocompromised host.³