Question

what could this 52 year old man possibly have? Is it right to rule out tuberculosis because acid-fast bacilli is negative? But why is his leucocyte so high could there be a chance of inflammation?

FOLLOW UP-ONE WEEK LATER Subsequently the patient became less responsive with a decreased level of consciousness and a low Glasgow Coma Scale score. A lumbar puncture was performed and revealed that there was no fungal smear and the acid-fast bacilli PCR was negative. Lumbar Puncture Result Reference Test range (< 45 Protein 314 mg/dL mg/dL) Lactate dehydrogenase 63 U/mL 7 U/mL) Total Leucocyte count 490 (90% lymphocytes (2- (0- 5) After two weeks his serum sodium continued to fall to 118 mEq/L with a high urine output (4L/24Hr) and a spot urinary sodium of 188 mEq/L (REFERENCE: 20-40 mEq) and a spot urine osmolarlity of 762 mosm/Kg. Fluid restriction did not improve the patient.

How the clinical history and the biochemical results aided your evaluation of the diagnosis. NOTE: you will need to research the relevance of measuring the fractional excretion of sodium. The underlying pathogenesis. What other conditions give rise to hyponatraemia and explain why these can be ruled out based on the clinical presentation.)

Answer 1

Probable diagnosis aseptic meningitis- viral meningitis

With acute renal damage

No bacterial because in bacterial increase nutrophils

In viral ,tb ,fungal predominant cell are lymphocytes so in this case culture for fungal and tb are negative

Sodium loss with water and increase serum creatinine indicate acute kidney injury with infection