ABSTRACT: Abstract Although tuberculous meningitis is rarely encountered in the United States, clinicians need to have a high index of suspicion for this disease. Intramuscular streptomycin is usually administered as part of a four-drug antituberculous regimen. However, we describe an 8-month-old girl who was diagnosed with Mycobacterium tuberculosis meningitis and received streptomycin intravenously. This route was chosen to avoid daily intramuscular injections because the infant had poor lean muscle mass. The patient's regimen consisted of isoniazid 15 mg/kg/day, rifampin 20 mg/kg/day, and pyrazinamide 40 mg/kg/day by nasogastric tube, and intravenous streptomycin 15 mg/kg twice/day administered using a controlled-rate infusion pump. The M. tuberculosis strain was subsequently found to be susceptible to all four antituberculous drugs. Her condition improved, and no drug toxicities were observed during her treatment course; isoniazid and rifampin were continued after discharge. The patient was readmitted 1 month later for mental status changes and right-sided weakness. Magnetic resonance scan of the brain revealed numerous solid and ring-enhancing hypointense tuberculomas in the suprasellar cistern, left medial temporal lobe, and brainstem, with significant secondary vasogenic edema as the cause of her symptoms. Although treatment failure was not suspected, cerebrospinal fluid and gastric cultures were tested; all were negative for M. tuberculosis. Dexamethasone was started for treatment of the focalized cerebral edema, presumably occurring from the breakdown of existing tuberculomas, and the patient rapidly improved. She was discharged and continued to receive oral antituberculous therapy for a total of 12 months. At her 1-year follow-up visit, the patient had recovered fully and had no apparent neurologic, otologic, or developmental deficits. The safe and effective use of intravenous streptomycin in this infant suggests that this route of administration may be an alternative to intramuscular streptomycin.
Pharmacotherapy 11/2010; 30(11):1197. · 2.90 Impact Factor