Tuberculous meningitis: successful use of delayed corticosteroids in treatment and polymerase chain reaction in diagnosis.

The diagnosis of tuberculous meningitis remains an enigma despite recent technologic advances, such as computerized tomography (CT), magnetic resonance imaging (MRI), and more recently, polymerase chain reaction of the cerebrospinal fluid. We report a patient with tuberculous meningitis who, when treated with appropriate antitubercular medications, made no progress in her recovery. Approximately 5 weeks into therapy, she began oral corticosteroid therapy and had a successful resolution of her neurologic deficits and intracranial symptoms. Polymerase chain reaction on four samples of cerebrospinal fluid was consistently negative for Mycobacterium tuberculosis. We describe the usefulness and problems associated with polymerase chain reaction and discuss the controversy regarding the late or delayed use of corticosteroids in the treatment of tuberculous meningitis ..