Intractable progressive pneumocephalus due to tuberculous meningoencephalitis

Abstract

A 25-year-old woman with preexisting systemic lupus erythematosus (SLE) was admitted to the hospital with fever and general fatigue. CSF examination revealed pleocytosis (40/mm3), high protein (120 mg/dL), and normal adenosine deaminase levels. Despite treatment with antiviral, antibiotic, and antituberculous medications, her mentation deteriorated with severe brain swelling and pneumocephalus (figure). Two weeks later, CSF tuberculous culture was positive without other coinfections detected. Nontraumatic pneumocephalus occurs rarely in tumor invasion and bacterial meningitis. However, tuberculous meningoencephalitis should be considered in immunocompromised patients such as those with SLE who may develop nontraumatic pneumocephalus.