Polymorphonuclear CSF Pleocytosis during the Treatment of Tuberculous Meningitis

ABSTRACT

Among 73 patients with possible and definite tuberculous meningitis, 14 cases showed a sudden unexpected polymorphonuclear (PMN) CSF pleocytosis during treatment. Patients with superimposed bacterial meningitis were excluded. Eleven patients(15. 1%) matched inclusion criteria. The intervals between the onset of the treatment and the onset of the PMN CSF pleocytosis were 7-54 days(mean 17.2+ 14.4 days). The mean duration of PMN CSF pleocytosis was 14.2+12.4 days. A PMN CSF pleocytosis may develop occasionally weeks or months after the start of the treatment for tuberculous meningitis. Though the cause is uncertain, we suggest that probably its cause is superimposed acute meningeal inflanunation by the release of Mycobacterium from tuberculomas or.delayed Jarisch-Herxheimer reaction.