Tuberculous meningitis: treat upon suspicion.

A 58-year-old man from Surinam was referred because of nausea, vomiting, weight loss, ascites and an altered mental state. Tuberculous meningitis was suspected upon examination of the cerebrospinal fluid and antituberculous treatment was initiated. However, the patient did not recover but developed haemiplegia with recurrent aspiration pneumonias. This case illustrates that empiric antituberculous treatment is warranted upon clinical suspicion, since no fast, sensitive diagnostic tests are available to date.