1/2 A Case of Abducense Nerve Palsy as a Rare Feature of Tuberculosis Meningoencephalitis Mohammad Rahmanian 1 , Zahra Mosallanezhad 2 , Mohamed Amin Ghobadifar 3 and Safar Zarei 4 * 1 Department of Anesthesiology, Shiraz University of Medical Sciences, Iran 2 Department of Obstetrics and Gynecology, Jahrom University of Medical Sciences, Iran 3 Zoonoses Research Center, Jahrom University of Medical Sciences, Iran 4 Department of Physiology, Jahrom University of Medical Sciences, Iran Received: May 17, 2018; Published: May 23, 2018 *Corresponding author: Safar Zarei, Department of Physiology, Jahrom University of Medical Sciences, Jahrom, Motahari Avenue, postal code 193, Jahrom, Iran, Tel: ; Fax: +98-713-635-40-94; Email: DOI: 10.26717/BJSTR.2018.04.001101 Safar Zarei. Biomed J Sci & Tech Res Cite this article: Mohammad R, Zahra M, Mohamed AG, Safar Z. A Case of Abducense Nerve Palsy as a Rare Feature of Tuberculosis Meningoencephalitis. Biomed J Sci &Tech Res 4(5)- 2018. BJSTR. MS.ID.001101. DOI: 10.26717/ BJSTR.2018.04.001101. Case Report Open Access Introduction The exact etiology of encephalitis is often unknown and a high rate of morbidity and mortality is associated with it. Number of studies in North America and Europe was done to find the etiol- ogy of encephalitis whether infectious or not, during the last dec- ades [1,2]. In this regard, a meta-analysis of a 41 analyzed studies showed that the most etiology of encephalitis is absence [3]. The most severe site of tuberculosis infection is tuberculosis enceph- alitis with recurrently atypical evolution and onset, an intensely polymorphic disease, and with rarely established etiological diag- nosis [1]. In spite of adequate treatment, tuberculosis encephalitis has a severe prognosis. Thus, tuberculosis encephalitis is known to be one of a severe health problem with high mortality rates. On the other hand, lack of safe and fast diagnostic algorithm often caus- es late specific treatment which finally increases the incidence of tuberculosis in general population [3]. Even though, tuberculosis meningitis is well defined, marked features of encephalitic are re- ported less commonly. Given this background, we aimed to describe the rare features of a case with tuberculosis encephalitis in this re- port. Case Report A 17-year-old woman from Iran country was admitted to Peymanieh hospital affiliated with Jahrom University of Medical Sciences complaining of fever, anorexia, photosensitivity, headache, agitation, confusion, impaired health status, positive signs of me- ningeal irritation, and diplopia of 2 days duration which developed overnight. The onset of disease with manifestation of fever, anorexia, and photosensitivity was about 15 days before hospitalization. The patient referred to an outpatient clinic and was evaluated by an internist. He received acetaminophen for his fever and headache and discharged. She didn’t become well, therefore transferred to our hospital. On admission: blood pressure 120/80 mmHg, heart rate 89/ min, respiratory and hemodynamic stable state, normal weight, confusion, influences general state, positive signs of meningeal irritation, diffuse headache, double vision of 2 days duration. A neurological examination revealed isolated right abducense nerve palsy which manifested as esotropia in primary gaze and paralysis of lateral rectus muscle on the right, but with no obvious papillary defect. Visual acuity and other cranial nerves were normal during examination. The paraclinical tests showed normal white blood cells count (5630/mm3) neutrophilia (64%), elevated erythrocyte sedimentation rate (105 ml/hr), positive C-reactive protein. The spiral CT-scan of the chest without contrast revealed multiple small milliary nodules in both lung fields. Biopsy tissue of lung showed no malignant cells, but polymerase chain reaction for Mycobacterium Tuberculosis was positive. A lumbar puncture was done which revealed pleocytosis (523 elem/mm3), 70% lymphocytosis, hight proteinorrhachia (112 mg/dl), low glycorrhachia (29 mg/dl). By suspicious to meningo-encephalitis tuberculosis which is confirmed by positive Lowenstein-Jensen culture for Mycobacte- rium Tuberculosis, we started treatment against tuberculosis with four agents together including (Rifampicin 750 mg + Ethambutol 1.5g + Isoniazide 250 mg + Pyrazinamide 1.5 g) with intravenous Ciprofloxacin. To reduce barin edema, dexamethasone was also injected. During treatment, because of increasing transaminase levels, we decreased Rifampicin doses. After 40 days treatment on these medications, her diplopia was disappeared with favorable evolution, and finally discharged in good general state, good orien- ISSN: 2574-1241