Autoimmune Glial Fibrillary Acidic Protein Astrocytopathy Mimicking Tuberculous Meningitis Following Epstein-Barr Virus Infection

A 49-year-old man with fever, progressive encephalopathy, lymphocytic pleocytosis, rising cerebrospinal fluid adenosine deaminase, Epstein-Barr virus DNA detection, and multifocal cerebral vasospasm was suspected of infectious or tuberculous meningitis, but repeated negative tests for tuberculosis and other pathogens and cerebrospinal fluid anti-glial fibrillary acidic protein (GFAP) antibody positivity established autoimmune GFAP astrocytopathy, which improved after methylprednisolone pulse therapy and plasma exchange.