Tuberculous meningitis initially presented with low levels of pleocytosis and protein in the cerebrospinal fluid: a case report

Tuberculous meningitis (TBM) is fatal unless treated promptly. Nonconvulsive status epilepticus (NCSE) may cause altered consciousness in patients with TBM. A 25-year-old female presented to the emergency department with a headache and fever along with multiple associated symptoms that had developed 2 days prior. Based on clinical findings, brain imaging, and cerebrospinal fluid (CSF) examination, she was tentatively diagnosed with viral meningitis. Later, she developed altered consciousness with focal seizures, and follow-up CSF examination findings and electroencephalography were consistent with NCSE complicated by TBM. We encountered a patient with TBM who exhibited initial atypical CSF findings and NCSE, and we report the case here and discuss the pathomechanisms.