PMID- 36400717
OWN - NLM
STAT- MEDLINE
DCOM- 20221122
LR  - 20221123
IS  - 1757-790X (Electronic)
IS  - 1757-790X (Linking)
VI  - 15
IP  - 11
DP  - 2022 Nov 18
TI  - Autoimmune glial fibrillar acidic protein astrocytopathy mimicking tuberculous 
      meningitis.
LID - 10.1136/bcr-2022-252518 [doi]
LID - e252518
AB  - 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.
CI  - (c) BMJ Publishing Group Limited 2022. No commercial re-use. See rights and 
      permissions. Published by BMJ.
FAU - Someko, Hidehiro
AU  - Someko H
AUID- ORCID: 0000-0002-7195-2055
AD  - General Internal Medicine, Asahi General Hospital, Asahi, Chiba, Japan 
      someko@med.kitasato-u.ac.jp.
FAU - Shiojiri, Toshiaki
AU  - Shiojiri T
AD  - General Internal Medicine, Asahi General Hospital, Asahi, Chiba, Japan.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20221118
PL  - England
TA  - BMJ Case Rep
JT  - BMJ case reports
JID - 101526291
RN  - 0 (Glial Fibrillary Acidic Protein)
RN  - 0 (Antibodies)
RN  - 0 (Adrenal Cortex Hormones)
SB  - IM
MH  - Male
MH  - Humans
MH  - *Tuberculosis, Meningeal/diagnosis/drug therapy
MH  - Glial Fibrillary Acidic Protein
MH  - *Meningoencephalitis/diagnosis/drug therapy
MH  - Antibodies
MH  - Adrenal Cortex Hormones
PMC - PMC9677027
OTO - NOTNLM
OT  - Headache (including migraines)
OT  - Neuroimaging
COIS- Competing interests: None declared.
EDAT- 2022/11/19 06:00
MHDA- 2022/11/23 06:00
PMCR- 2024/11/17
CRDT- 2022/11/18 22:12
PHST- 2024/11/17 00:00 [pmc-release]
PHST- 2022/11/18 22:12 [entrez]
PHST- 2022/11/19 06:00 [pubmed]
PHST- 2022/11/23 06:00 [medline]
AID - 15/11/e252518 [pii]
AID - bcr-2022-252518 [pii]
AID - 10.1136/bcr-2022-252518 [doi]
PST - epublish
SO  - BMJ Case Rep. 2022 Nov 18;15(11):e252518. doi: 10.1136/bcr-2022-252518.