A 34-year-old man from a rural district has 6 weeks of low-grade fever, evening headache, and weight loss. Examination shows neck stiffness and right sixth nerve palsy. CSF shows 80 cells/microlitre with lymphocyte predominance, protein 250 mg/dL, glucose 30 mg/dL (paired blood glucose 110 mg/dL), and a fine web-like coagulum on standing. What is the most likely diagnosis?

• A Pyogenic meningitis
• B Tuberculous meningitis ✓
• C Viral meningoencephalitis
• D Cryptococcal meningitis

Explanation

Subacute lymphocytic meningitis with markedly raised protein, low glucose, cranial nerve palsy from basal exudates, and the characteristic cobweb coagulum is classic for tuberculous meningitis. Pyogenic meningitis presents acutely with neutrophil predominance and very low glucose. Viral meningitis usually has near-normal glucose and protein. Cryptococcus can mimic these findings but is seen mainly in immunosuppressed patients and lacks the basal exudate picture.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.