Streptomycin in Tuberculous Meningitis Report of a Case

¹ The Veterans Administration Center, Dayton, Ohio.

A case of a man with proven tuberculous meningitis is presented. After initial streptomycin therapy was instituted, he showed marked clinical improvement. When the drug was discontinued he suffered a severe relapse. Renewal of streptomycin therapy was barely able to stave off a fatal termination but after four additional months of treatment he slowly progressed to a point where it was deemed feasible to discontinue the drug. He received about 160 grams of streptomycin in seven and one-half months by the intramuscular and intrathecal routes. His course after treatment was marred by one relatively short, self-limited episode of ascites and an attack of acute appendicitis for which an appendectomy was performed. Symptomatic therapy played a large part in combating his disease. Certain findings which persisted for several months after therapy but which eventually disappeared completely, were headache and haziness of vision. Other findings which improved after therapy but which still persist are slight ataxia and high tone deafness. The patient seems to be adequately compensating for his vestibular dysfunction. All during his illness and up to the present time he has been receiving pneumothorax refills. The chest lesion shows no change and the sputum is still negative. Twenty-two months have passed since the onset of his disease, the last six of which he has spent at home with no ill effects.

Considering the percentage of fatality in tuberculous meningitis, even since the advent of streptomycin, it is felt that this patient has progressed remarkably, possibly further than any that have been treated with this drug, and it is hoped that as time goes on the possibility of a relapse will become even more remote. October 15, 1948, still well clinically.