Tuberculous Meningitis-Mimicking Varicella-Zoster Meningitis

Sun In Hong; Taeeun Kim; Jiwon Jung; Se Yoon Park; Yong Pil Chong; Sang Oh Lee; Sang Ho Choi; Yang Soo Kim; Jun Hee Woo; Sang Ahm Lee; Sung Han Kim

doi:10.3947/ic.2017.49.2.123

Tuberculous Meningitis-Mimicking Varicella-Zoster Meningitis

Infect Chemother. 2017 Jun;49(2):123-129. doi: 10.3947/ic.2017.49.2.123.

Authors

Sun In Hong¹, Taeeun Kim², Jiwon Jung³, Se Yoon Park⁴, Yong Pil Chong⁵, Sang Oh Lee⁵, Sang Ho Choi⁵, Yang Soo Kim⁵, Jun Hee Woo⁵, Sang Ahm Lee⁶, Sung Han Kim⁷

Affiliations

¹ Division of Infectious Diseases, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea.
² Division of Infectious Diseases, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.
³ Division of Infectious Diseases, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
⁴ Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
⁵ Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
⁶ Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
⁷ Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. kimsunghanmd@hotmail.com.

Abstract

Background: Varicella-zoster virus (VZV) is one of the most common etiologies of aseptic meningitis. The severest manifestation of VZV meningitis is occasionally confused with tuberculous meningitis (TBM). Thus, we investigated the clinical manifestations of VZV meningitis as compared with those of TBM.

Materials and methods: All adult patients who were diagnosed with VZV meningitis or TBM were enrolled at a tertiary hospital in Seoul, South Korea, during an 8-year period. The clinical characteristics and cerebrospinal fluid (CSF) profile of patients were analyzed.

Results: Seventy-nine patients with VZV meningitis and 24 patients with TBM were enrolled in this study. Of the 79 patients with VZV meningitis, 63 (80%) did not received empirical anti-tuberculous therapy (Group 1) and the remaining 16 (20%) received empirical anti-tuberculous therapy (Group 2), compared with 24 patients with TBM (Group 3). Altered mental status, intensive care unit (ICU) admission, neurologic sequelae, CSF protein levels, and CSF adenosine deaminase levels revealed a trend of being higher in Group 3 than Group 2, which was higher than Group 1. However, the CSF/serum glucose ratio was significantly lower in Group 3 than in Group 1 or Group 2.

Conclusion: About one fifth of VZV meningitis cases presented as severe manifestations, mimicking TBM. The CSF/serum glucose ratio might be useful to differentiate VZV meningitis from TBM until definite diagnostic tests are available. Physicians should keep in mind that a differential diagnosis between severe VZV meningitis and TBM is needed.

Keywords: Herpesvirus 3, Human; Tuberculosis, Meningeal.