Hyponatremia in Tuberculosis Meningitis: Navigating the Diagnostic Challenges of Cerebral Salt Wasting – A Case Report

Authors

  • Yousra Nasir Siddiqui

DOI:

https://doi.org/10.51985/JBUMDC2023270

Keywords:

SIADH; tuberculous meningitis; cerebral salt wasting; hyponatremia; fludrocortisone

Abstract

A 10 year old female presented with fever, headache and vomiting since four days. Her laboratory workup revealed low serum sodium, serum osmolality. CT scan of the brain was unremarkable, while on CSF examination, protein, and total leukocyte count (predominantly lymphocytes) were increased. CSF cultures were negative, however, GeneXpert detected rifampicin resistant mycobacterium tuberculosis. Due to her high urine output and hyponatremia with sodium of 128 mEq/l, fluid restriction was attempted in order to rule out the diagnosis of SIADH, but the patient was unresponsive to it. Thus, the patient was diagnosed with tuberculous meningitis after further workup, followed by cerebral salt wasting. She was started on anti-tuberculous therapy (ATT), 3% hypertonic saline and flucrocortisone, to which she was responsive, and eventually discharged.

References

Merkler AE, Reynolds AS, Gialdini G, Morris NA, Murthy

SB, Thakur K, et al. Neurological complications after

tuberculous meningitis in a multi-state cohort in the United

States. 2017;375:460-3. https://doi.org/10.1016/ j.jns.2017.

051

Misra UK, Kalita J, Research TMIRCJWO. Mechanism,

spectrum, consequences and management of hyponatremia

in tuberculous meningitis. 2019;4. 10.12688/ wellcomeopenres.

2

Basit MB, Kitchlew R, Riaz MM, Anjum KM, Leena

HJPJoKD. CSW in a Patient with tuberculous meningitis

intertiary Care hospital. 2017;1(1):31-3. https://doi.org/

53778/pjkd1115

Inamdar P, Masavkar S, Shanbag PJJoPN. Hyponatremia in

children with tuberculous meningitis: a hospital-based cohort

study. 2016;11(3):182. 10.4103/1817-1745.193376

Jabbar A, Farrukh SN, Khan RJJotPMA. Cerebral salt wasting

syndrome in tuberculous meningitis. 2010;60(11):964.

https://ecommons.aku.edu/pakistan_fhs_mc_med_intern_m

ed/14

Ahmad S, Majid Z, Mehdi M, Mubarak MJJorip. Cerebral

salt wasting syndrome due to tuberculous meningitis; a case

report. 2016;5(1):53. 10.15171/jrip.2016.12

Memon W, Akram A, Popli K, Spriggs JB, Rehman S, Gipson

G, et al. Cerebral Salt-Wasting Syndrome in a Patient With

Active Pulmonary Tuberculosis. 2022;14(1). 10.7759/ cureus.

Kubre J, Goyal V, Saigal S, Sharma J, Joshi RJNI. Tuberculous

meningitis presenting as cerebral salt wasting syndrome: a

review of literature with clinical approach to hyponatremia.

;69(1):190. 10.4103/0028-3886.310074

Tunio YM, Farhad R, Channa R, Bawany MA, Ravender R,

Kaleem MJPJoM, et al. Frequency of Hyponatremia in Patients

with Tuberculosis Bacterial Meningitis: A Cross Sectional

Study. 2022;16(02):1037-https://doi.org/10.53350/ pjmhs

Khan IAJPJoM, Dentistry. Cerebral Salt Wasting Syndrome

(CSWS) and Potentially Fatal Neurosurgical Hyponatremia.

;10(3):54-9. https://doi.org/10.36283/PJMD10-3/010

Downloads

Published

2024-01-29

How to Cite

Siddiqui , Y. N. . (2024). Hyponatremia in Tuberculosis Meningitis: Navigating the Diagnostic Challenges of Cerebral Salt Wasting – A Case Report. Journal of Bahria University Medical and Dental College, 14(01), 93–95. https://doi.org/10.51985/JBUMDC2023270