A rare case of tuberculous meningitis with concurrent HHV-7 encephalitis in an immunocompetent host: radiological clues to a diagnostic challenge

Sharidon, Nuratiqah Izzah and Wan Ramli, Wan Nurliyana and Gunasegaran, Subashini and Sohaimi, Ainur Elliana and Saiful Suhardi, Mohd Aiman and Musatafa, Farah Hazwani and Wan Mustapha, Wan Irfan and Hassan, Radhiana and Wahab, Mohd Ghaddafi and Basiam, Sulaila and Ibrahim, Nur Munirah and Noordin, Noorlina and Mohamad, Dzawani (2025) A rare case of tuberculous meningitis with concurrent HHV-7 encephalitis in an immunocompetent host: radiological clues to a diagnostic challenge. In: The 20th Asia Pacific Congress of Clinical Microbiology and Infection, 2-4 Nov 2025, Bangkok, Thailand.

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Abstract

Introduction Human herpesvirus 7 (HHV-7) encephalitis is rare in immunocompetent individuals and may clinically mimic tuberculous meningitis (TBM). Magnetic resonance imaging (MRI) plays a vital role in differentiating central nervous system (CNS) infections, particularly when patients fail to respond to standard empirical therapy. Case Presentation A 21-year-old immunocompetent female presented with a two-week history of fever, headache, vomiting, and altered mental status. Examination revealed meningeal irritation signs with a Glasgow Coma Scale score of 13/15. Initial investigations showed leukocytosis, elevated ESR, and cerebrospinal fluid (CSF) features consistent with meningitis. She was empirically started on intravenous ceftriaxone and acyclovir, later escalated to meropenem. Repeat CSF analysis revealed elevated opening pressure, high protein, and a low CSF:serum glucose ratio. Due to persistent fever and lymphocytic pleocytosis, empirical antituberculous therapy was initiated on day 7. Serial contrast-enhanced CT scans demonstrated progression from cerebritis to obstructive hydrocephalus, necessitating Omaya shunt insertion and intravenous dexamethasone. Despite therapy, her neurological symptoms persisted. CSF viral PCR was subsequently positive for HHV-7, and MRI brain showed leptomeningeal enhancement involving the basal cisterns, midbrain, and bilateral frontal and temporal lobes, with periventricular T2/FLAIR hyperintensities. IV ganciclovir was initiated on day 11, leading to significant clinical improvement at day 5 of therapy. She completed 14 days of antimicrobial therapy and continued anti-TB treatment for six months. Conclusion This case highlights the diagnostic complexity of overlapping CNS infections. MRI played a pivotal role in identifying atypical radiological features suggestive of viral encephalitis, supporting the diagnosis of HHV-7 infection and enabling timely, targeted antiviral therapy.

Item Type:	Proceeding Paper (Poster)
Subjects:	R Medicine > RC Internal medicine > RC111 Infectious and Parasitic Diseases
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Medicine Kulliyyah of Medicine > Department of Internal Medicine Kulliyyah of Medicine > Department of Radiology
Depositing User:	Dr Wan Nurliyana Wan Ramli
Date Deposited:	03 Feb 2026 16:04
Last Modified:	03 Feb 2026 16:04
Queue Number:	2026-01-Q1958
URI:	http://irep.iium.edu.my/id/eprint/127208

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