Tubercular meningitis presenting as cerebral salt wasting syndrome in an adult: A case report

Abstract Introduction CSWS is one of the causes of hyponatremia in the setting of intracranial pathologies such as CNS trauma, infections, and tumors. It is important to differentiate CSWS from SIADH as their management differs. CSWS leads to hypovolemia as opposed to euvolemia or hypervolemia in SIADH. SIADH is managed with fluid restriction and this could worsen CSWS which is managed with IV crystalloids to correct hyponatremia. Case summary A 42-year-old male was admitted after a week-long low-grade fever with easy fatigability, hypersomnolence, and excessive thirst. He had polyuria 5 days before, and unintentionally lost 3 kg of weight in the past month. He had orthostatic hypotension, and was dehydrated, otherwise, vitals except temperatures were normal.CSF analysis revealed a tubercular pattern with glucose 42 mg/dl, protein 170 mg/dl, cell count 28/mm3 with 65% lymphocytes. CSF AFB culture was eventually positive along with CSF PCR for M. tuberculosis (gene expert). Discussion Presentation may be non-specific and its insidious onset could lead to delayed or missed diagnosis; however persistent constitutional symptoms and signs with history of weight loss and infectious contact may raise the possibility of tuberculosis. Early diagnosis and treatment has an excellent prognosis, but any delay contributes to death and disability despite ATT.CSWS should be managed with salt and volume replacement, but more importantly, the causative CNS insult should also be addressed.