Abstract Details

Title Primary Diffuse Leptomeningeal Gliomatosis, a Rare Mimic of Tuberculous Meningitis

Topic Neuro-oncology

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 7-004

Objective

We describe a patient who was initially diagnosed as TB meningitis but was then later found to have Primary Diffuse Leptomeningeal Gliomatosis (PDLMG).

Background PDLMG is characterized by infiltration of the leptomeninges by malignant glial cells of varied pathology (astrocytoma, oligodendroglioma, glioblastoma, and ependymoblastoma), without involvement of brain parenchyma or spinal cord. About 50 cases were reported in the last 3 decades. The median age is 34 years and there is no gender predilection. The most common misdiagnosis is TB (>30% of patients received anti-tuberculous medications) and PDLMG diagnosis is often made late in the disease course or even post-mortem.

Design/Methods A 44 year old Hispanic male who recently moved to the United States complained of a 4 month history of fatigue, nausea, and occipital headache. His symptoms continued to worsen and he was seen 3 times in a local Emergency Department (ED) until he was diagnosed with tuberculous meningitis based on CSF results and QuantiFERON®-TB Gold test. He was started on anti-tuberculous medications (RIPE therapy). His symptoms worsened and he presented to Tertiary Care Center ED with sweating, chills, headache, neck stiffness, nausea, vomiting and blurry vision for which he was admitted for further work up.

Results

MRI of the brain showed extra-axial lesions with mixed leptomeningeal and dural nodular enhancement. CSF analysis showed 20 WBCs, protein level of 267 mg/dl, blood glucose 26 mg/dl. CSF cytology was suspicious for malignancy. TB PCR from CSF was negative. A leptomeningeal biopsy was obtained which showed diffuse multi-nodular leptomeningeal gliomatosis with high-grade histological features. He started craniospinal radiotherapy but continued to experience functional decline and expired 5 weeks after the diagnosis was made.

Conclusions PDLMG is a very rare malignancy with poor prognosis. Early diagnosis may improve overall survival. Future studies are needed to investigate more efficacious treatment modalities.

Authors/Disclosures
Mina Lobbous, MD (Cleveland Clinic Foundation) PRESENTER	Dr. Lobbous has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Servier . Dr. Lobbous has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion Pharmaceuticals . Dr. Lobbous has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Telix pharmaceuticals . Dr. Lobbous has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Springworks Pharmaceuticals . Dr. Lobbous has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Springworks Pharmaceuticals . Dr. Lobbous has received publishing royalties from a publication relating to health care.
Paula P. Warren, MD (The Headache Specialists, PLLC)	No disclosure on file

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