Monicah died of TB meningitis.

She had no evidence of TB outside of the CNS. The CSF in TB meningitis typically shows Elevated WBC count, consisting of lymphocytes and monocytes. Profoundly elevated protein. Glucose tends to be normal Acid fast stain is iffy under the best of circumstances.

Treatment of suspected TB meningitis should consist 4-drug regimen plus steroids.

Monicah's differential included

• Cryptococcal meninitis, bacterial meningitis,
• Toxoplasmosis (which may be missed on large CT cuts)
• CNS mass or abscess and CVA

An isolated, slightly elevated CSF protein may be seen with HIV itself, viral or chronic meningitis. A very high CSF protein is highly suggestive of tuberculosis.

A seventeen year old boy with a seizure.