Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 May 6;61(3):163-166.
doi: 10.2478/rjim-2023-0010. Print 2023 Sep 1.

Challenges in the diagnosis of leptomeningeal dissemination of glioblastoma in a patient with fever and xanthochromic CSF: a case report

Andrei Neagu  1   2 , Cristian-Mihail Niculae  1   2 , Irina Lăpădat  2 , Adriana Hristea  1   2
Affiliations
Case Reports

Challenges in the diagnosis of leptomeningeal dissemination of glioblastoma in a patient with fever and xanthochromic CSF: a case report

Andrei Neagu et al. Rom J Intern Med. .

Abstract

Background: Leptomeningeal spread with carcinomatous meningitis is a severe complication of glioblastoma, with a poor prognosis. Diagnosis is challenging, as the sensitivity of classic diagnostic investigations remains low for detecting cerebrospinal fluid (CSF) tumor spread and exclusion of infectious causes is mandatory, especially if unusual clinical findings are present.

Case presentation: A 71-year-old woman was admitted to our hospital for recurrent episodes of high fever and xanthochromic meningitis, with subacute onset. Her past medical history was significant for a left temporal glioblastoma, treated with surgical resection and adjuvant chemo- and radiotherapy, with associated systemic immunosuppression secondary to chemotherapy. An extensive workup especially with molecular microbiology testing for exclusion of infectious causes was performed. CSF was analyzed for typical bacterial and viral causes, but also pathogens associated with immunosuppression, such as Listeria monocytogenes and Cryptococcus neoformans. A therapeutic trial of standard antituberculous drugs with repeated lumbar punctures were needed in order to exclude Mycobacterium tuberculosis and to confirm the diagnosis of carcinomatous meningitis by cytopathological examination of the CSF.

Conclusions: The case describes an unusual clinical presentation of a patient with glioblastoma associated leptomeningeal dissemination, as high fever and xanthochromic CSF could raise important diagnostic and therapeutic challenges in the clinical practice. The diagnosis of carcinomatous meningitis requires an extensive workup for exclusion of infectious causes which is important for urgent oncologic treatment.

Keywords: fever; glioblastoma; meningitis; xanthochromic CSF.

PubMed Disclaimer

References

    1. BIRZU C, TRAN S, BIELLE F, TOUAT M, MOKHTARI K, YOUNAN N, et al. Leptomeningeal Spread in Glioblastoma: Diagnostic and Therapeutic Challenges. Oncologist. 2020;25(11):e1763–e1776.
    1. LOUIS DN, PERRY A, WESSELING P, BRAT DJ, CREE IA, FIGARELLABRANGER D, et al. The 2021 WHO classification of tumors of the central nervous system: A summary. Neuro. Oncol. 2021;23:1231–1251.
    1. NOH JH, LEE MH, KIM WS, LIM DH, KIM ST, KONG DS, et al. Optimal treatment of leptomeningeal spread in glioblastoma: analysis of risk factors and outcome. Acta Neurochir. (Wien). 2015;157:569–576.
    1. WANG N, BERTALAN MS, BRASTIANOS PK. Leptomeningeal metastasis from systemic cancer: Review and update on management . Cancer [Internet] 2018; 124: 21–35.
    1. NAYAR G, EJIKEME T, CHONGSATHIDKIET P, ELSAMADICY AA, BLACKWELL KL, CLARKE JM, et al. Leptomeningeal disease: current diagnostic and therapeutic strategies . Oncotarget. 2017;8(42):73312–73328.

Publication types