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Case Reports: Reminder of important clinical lesson
Autoimmune glial fibrillar acidic protein astrocytopathy mimicking tuberculous meningitis
  1. Hidehiro Someko and
  2. Toshiaki Shiojiri
  1. General Internal Medicine, Asahi General Hospital, Asahi, Chiba, Japan
  1. Correspondence to Hidehiro Someko; someko{at}med.kitasato-u.ac.jp

Abstract

Autoimmune glial fibrillar acidic protein (GFAP) astrocytopathy typically presents as acute or subacute meningoencephalitis with or without myelitis. We describe a case of autoimmune GFAP astrocytopathy that mimicked tuberculous meningitis. A man in his 70s was referred to our hospital with lethargy persistent for 2 months, appetite loss for 1 month and fever with headache for 10 days. The cerebrospinal fluid test revealed lymphocytic pleocytosis with elevated adenosine deaminase (ADA). Laboratory investigations ruled out microbial and neoplastic causes. Empirical therapy for tuberculous meningitis combined with corticosteroid improved the patient’s condition. Culture for Mycobacterium tuberculosis failed to show microbial growth despite 1 month of incubation. The cerebrospinal fluid was examined for GFAP antibody and returned positive result. Antituberculous agents were discontinued, and corticosteroid was administered until patient’s symptoms resolved completely. Thus, clinicians should consider autoimmune GFAP astrocytopathy as one of the differential diagnoses of lymphocytic meningitis with elevated ADA.

  • Neuroimaging
  • Headache (including migraines)

https://doi.org/10.1136/bcr-2022-252518

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    Footnotes

    • Contributors HS wrote the manuscript. TS revised the manuscript critically. HS and TS approved the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.