The polymerase chain reaction (PCR) has been reported to be of diagnostic value when performed on CSF samples in tuberculous meningitis.1-4 Rapid amplification ofMycobacteruim tuberculosis specific DNA enables results to be available within 48 hours and can influence treatment decisions.

Recently two patients presented to our hospital with symptoms and signs suggestive of tuberculous meningitis. Examination of CSF disclosed a lymphocytic exudate. Repeated samples were sent to a British referral laboratory where CSF PCR for M tuberculosiswas reported negative. Despite this, antituberculous treatment was continued for 12 months and both patients responded clinically. Several weeks after the negative PCR result, M tuberculosis was cultured on Lowenstein-Jensen slopes from CSF taken from both patients. False negative CSF PCR in tuberculous meningitis established by culture has rarely been reported. The two patients are described to emphasise the dangers of overreliance on PCR in cases of suspected tuberculous meningitis. Premature cessation of treatment would have had tragic consequences for the two patients concerned.

The first …