# Tuberculous Meningitis With Persistent Hiccups: A Case Report

## TL;DR

A 69-year-old man with unusual symptoms like persistent hiccups was diagnosed with tuberculous meningitis after initial tests were inconclusive.

## Contribution

Highlights persistent hiccups as an atypical but diagnostic clue for tuberculous meningitis.

## Key findings

- Persistent hiccups and headache were atypical symptoms of TBM in a patient with negative microbiological tests.
- Elevated CSF adenosine deaminase levels supported the TBM diagnosis despite lack of intracranial lesions on imaging.
- Early empirical treatment based on clinical suspicion led to clinical improvement.

## Abstract

A 69-year-old Japanese male presented with atypical symptoms of tuberculous meningitis (TBM), including intermittent left temporal headache and persistent hiccups that were unresponsive to initial therapies. Despite comprehensive imaging, no definitive intracranial lesions were identified. His persistent hiccups, along with typical meningitis symptoms, highlighted the diagnostic challenges of TBM, particularly in the context of negative microbiological tests. Early empirical treatment, initiated based on clinical suspicion and elevated cerebrospinal fluid (CSF) adenosine deaminase levels, led to clinical improvement and supported a diagnosis of TBM. This case underscores the importance of considering TBM in patients with unusual symptoms, such as persistent hiccups, to prevent delays in diagnosis and treatment.