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Diagnostic Challenge: Tuberculous Meningitis in a 68-Year-Old Male

This case presents a 68-year-old man admitted with confusion and decreased mental status, who later died. An autopsy revealed thickened leptomeninges with increased cellularity and numerous granulomatous nodules in the spinal cord. Acid-fast staining led to the identification of positive bacilli, confirming a diagnosis of tuberculous meningitis. This case emphasizes the importance of recognizing neurological symptoms associated with infectious processes, particularly in elderly patients.

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Diagnostic Challenge: Tuberculous Meningitis in a 68-Year-Old Male

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  1. Diagnostic ChallengePathology for Neurosurgery & Neurology ResidentsDepartment of PathologyUniversity of Oklahoma Health Sciences Center,Oklahoma City, OK, U.S.A. Case 21 History: A 68 year-old man was admitted for confusion and decreased mental status. He died later and an autopsy was performed. Author: Kar-Ming Fung, M.D., Ph.D., karming-fung@ouhsc.edu Last updtaded: 5/5/2008

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  4. Acid Fast Stain

  5. What is your diagnosis?

  6. Diagnosis: Tuberculous meningitis. • Discussion: • The leptomeninges is thickened and have increased cellularity (white arrow) in the spinal cord. Many small nodules are there (black arrow) and these are granulomas. The center of the granulomas have caseous necrotic center (n). • On acid fast stain, positive bacilli are cultured out (red arrow). n

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