Abstract Details

Title Headache in a Case of Tuberculosis: Think Beyond Meningitis

Topic Headache

Presentation(s) P11 - Poster Session 11 (8:00 AM-9:00 AM)

Poster/Presentation
Number 12-006

Objective NA

Background Intracranial hypertension may be primary (idiopathic) or secondary to some underlying conditions like intracranial space occupying lesions. There are several drugs like tetracycline, sulfamethoxazole, and gentamicin which are associated with raised intracranial pressure. Fluoroquinolones has bactericidal activity against mycobacterium tuberculosis and is an important drug in the treatment of multidrug-resistant tuberculosis (MDR-TB).

Design/Methods We are reporting a case of MDR-TB, who was on antitubercular therapy (Bedaquiline, Linezolid, Levofloxacin, Cycloserine, Clofazamine, Pyridoxine) had developed holocranial headache and binocular diplopia for eight days. There was no history of photophobia, phonophobia, lacrimation, redness, ocular pain, or diminution of vision. Examination revealed normal visual acuity and bilateral papilledema. Rest of the systemic examination was within normal limit.

Results Cerebrospinal fluid study was unremarkable except raised opening pressure (36 cm of water). Magnetic resonance imaging revealed left transverse and sigmoid sinus stenosis. A probable diagnosis of levofloxacin induced intracranial hypertension was made and the drug was stopped. The symptoms resolved within one week of levofloxacin cessation and the papilledema resolved within 2 weeks. Patient continued the regimen for MDR-TB with substitution of levofloxacin by pyrazinamide. There was no recurrence of symptoms during further follow-up.

Conclusions Levofloxacin, a fluoroquinolone, is commonly used for respiratory/urinary tract infection or as antitubercular therapy. It can rarely cause increase in intracranial pressure. Hence, one should have a high index of suspicion while evaluating a case with features of raised intracranial pressure, unremarkable investigation findings and taking levofloxacin as part of therapy.

Authors/Disclosures
Anand Kumar, MD, DM (Institute of Medical Sciences BHU) PRESENTER	Dr. Kumar has nothing to disclose.
Varun K. Singh, MD, MBBS (IMS, BHU)	Dr. Singh has nothing to disclose.
Sanchit S. Chouksey, MD, MBBS	Dr. Chouksey has nothing to disclose.
Rameshwar N. Chaurasia, MD, DM, FRCP (Edin), FAMS (Institute of Medical Sciences, Banaras Hindu University)	Dr. Chaurasia has nothing to disclose.
Abhishek Pathak, MD, MBBS, DM (Dept of Neurology)	Dr. Pathak has nothing to disclose.
Deepika Joshi, MD (Banaras Hindu University)	Dr. Joshi has nothing to disclose.
Vijaya Mishra, MD, MBBS, DM (Department of Neurology, Institute of Medical Sciences, Banaras Hindu University)	Prof. Mishra has nothing to disclose.
Pratishtha Sengar (IMS, BHU)	No disclosure on file

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