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Chronic Meningitis — SCE Infectious Diseases MCQ

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HardCNS InfectionChronic MeningitisSCE Infectious Diseases

A patient has chronic lymphocytic meningitis and CT shows accessible bulky hilar lymphadenopathy. CSF cultures and cytology are repeatedly negative. Which next investigation is most likely to yield a diagnosis with lower risk than meningeal biopsy?

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Correct answer: B — Image-guided or EBUS-guided biopsy of the hilar lymph nodes for histology and microbiology

The best answer is “Image-guided or EBUS-guided biopsy of the hilar lymph nodes for histology and microbiology”. Accessible extracranial tissue is preferred when sarcoidosis, tuberculosis or lymphoma could explain both findings; samples should be sent for histology, culture and molecular testing before immunosuppression. Non-caseating granulomas support sarcoidosis only after infection and other granulomatous causes are excluded; treatment depends on organ risk and symptoms. NICE specifies UK testing, latent-infection treatment and drug-susceptible tuberculosis regimens.

Reference: BTS clinical statement on pulmonary sarcoidosis: https://thorax.bmj.com/content/76/1/4 NICE NG33: tuberculosis: https://www.nice.org.uk/guidance/ng33/chapter/Recommendations