ANGIOSTRONGYLUS CANTONENSIS EOSINOPHILIC MENINGITIS MIMICKING TUBERCULOUS MENINGITIS CONFIRMED BY CEREBROSPINAL FLUID PCR: A DIAGNOSTIC CHALLENGE IN A TROPICAL COUNTRY

Tóm tắt

Background: Eosinophilic meningitis is a rare clinical syndrome most commonly caused by Angiostrongylus cantonensis, particularly in tropical regions. Because clinical manifestations and cerebrospinal fluid findings may overlap with tuberculous meningitis, misdiagnosis may occur, especially in tuberculosis-endemic countries. Clinical Case: We report a 45-year-old woman presenting with prolonged fever and headache. Cerebrospinal fluid analysis revealed marked pleocytosis, elevated protein levels, and reduced glucose concentration, with a small proportion of eosinophils. Initial microbiological investigations were negative, and the patient was empirically treated for tuberculous meningitis with adjunctive corticosteroids, resulting in transient clinical improvement. However, subsequent molecular testing of cerebrospinal fluid detected Angiostrongylus cantonensis DNA by polymerase chain reaction, establishing the diagnosis of eosinophilic meningitis. Anti-tuberculosis therapy was discontinued, and the patient recovered completely with supportive management. Conclusion: This case highlights the diagnostic challenge of eosinophilic meningitis mimicking tuberculous meningitis in tuberculosis-endemic settings. Molecular detection of Angiostrongylus cantonensis in cerebrospinal fluid plays a crucial role in establishing the correct diagnosis and preventing unnecessary anti-tuberculosis treatment.