• Nobuyuki Ashizawa, Ryotaro Kubo, Ryuta Tagawa, Yuya Ito, Kazuaki Takeda, Shotaro Ide, Naoki Iwanaga, Ayumi Fujita, Masato Tashiro, Takahiro Takazono, Takeshi Tanaka, Atsushi Nagaoka, Shunsuke Yoshimura, Kenta Ujifuku, Tomohiro Koga, Koji Ishii, Kazuko Yamamoto, Akitsugu Furumoto, Koichi Izumikawa, Katsunori Yanagihara, and Hiroshi Mukae.
• Infection Control and Education Center, Nagasaki University Hospital, Japan.
• Intern. Med. 2024 Feb 15; 63 (4): 583586583-586.

AbstractTuberculous meningitis is an infectious disease with high mortality. Literature describing intrathecal therapy for tuberculous meningitis is scarce. We herein report a case of refractory tuberculous meningitis in a 52-year-old woman with underlying neuropsychiatric systemic lupus erythematosus. Despite systemic treatment with anti-tuberculosis drugs and dexamethasone, her meningeal irritation deteriorated. Intrathecal isoniazid and prednisolone administration was therefore initiated, and the symptoms of severe meningeal irritation improved along with head magnetic resonance imaging and cerebrospinal fluid findings. This case report highlights the efficacy of intrathecal isoniazid and steroid injections for refractory tuberculous meningitis, particularly in patients with severe meningeal irritation.

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