A 19 year old girl, with no comorbidities, admitted with 2 day history of high grade fever and 1 episode of partial convulsions followed by secondary generalisation.
On admission, patient irritable, irrelevant talk; no focal deficit, Pupils- bilaterally equal in size and reacting to light. Vitals stable, systemic examination normal.
All blood investigations within normal limits. MRI Brain normal. CSF examination on day of admission – Clear in appearance, sugar 60mg/dl (RBS 110 Mg/dl), Proteins = 60, Chloride= 121, Cell count= 190 (95% Monocytes).
Treated with blanket cover - Ceftriaxone , Acyclovir, Anti TB, Solumedrol
Patient after admission, developed Status epilepticus, Treated with phenytoin, leviracetam, valproate, topiramate, carbamazepine and infusion midazolam.
Repeat CSF after 5 days: Sugar 75 mg/dl (RBS=130), Proteins = 40, Cell count 95 ( 95% Monocytes). CSF PCR= positive for non tuberculous mycobacteria.
Patient shifted to our hospital after 10 days of her illness. Is unconscious, minimally withdraws to deep pain, Pupils- bilaterally equal reacting to light. No focal deficit. Breathing spontaneously, maintains saturation on room air. Vitals stable. Systemic examination normal. Blood investigations normal, except SGOT=249, SGPT = 194. On leviracetam, Valproate, Carbamazepine. Anti TB medications stopped in view of deranged liver profile. Patient again developed Generalised convulsions after admission.
Please give your suggestions.