Mystery Case: Neurocutaneous melanosis with diffuse leptomeningeal malignant melanoma in an adult

Abstract

A 35-year-old man presented with a history of headache, vomiting, and visual blurring of 6 months' duration. Two months after the onset of symptoms, he developed behavioral changes in the form of irrelevant talking. He was then seen at another center where the clinical possibility of tuberculous meningitis was considered. His CSF findings at this time were 4 cells, all lymphocytes, protein 221 mg/dL (2.21 g/L), and glucose 59 mg/dL (3.3 mmol/L). A noncontrast CT head showed hydrocephalus (figure, B). He was treated with antitubercular treatment (ATT) and oral dexamethasone. He improved transiently but worsened again and presented to us with increasing headaches, recurrent vomiting, deterioration in vision, alteration in behavior, psychosis, and bilateral lower limb weakness of 10 days' duration.