Intracranial tuberculomas developing while on therapy for pulmonary tuberculosis

Nicolls, Deborah; King, Mark D.; Holland, David; Bala, J.; Rı́o, Carlos del

doi:10.1016/s1473-3099(05)70299-1

Cited by 103 publications

(72 citation statements)

References 30 publications

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“…Sin embargo, varias publicaciones mencionan que el desarrollo de tuberculomas cerebrales como reacción paradojal no solo se observa en pacientes en tratamiento por meningitis tuberculosa, sino también en pacientes con tuberculosis pulmonar o extrapulmonar de otras localizaciones. 3,4,14 Coincidimos con estos autores en señalar que quizás por la gravedad de la tuberculosis del SNC se reportan más casos de reacción paradojal de esta localización que de otros órganos.…”

Section: Discussionunclassified

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Reacción paradojal en meningitis tuberculosa. Presentación de un caso

González

Ponte

2014

Arch Argent Pediat

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RESUMENLa afectación del sistema nervioso central es una de las localizaciones extrapulmonares de la tuberculosis con peor pronóstico. El retraso en el diagnóstico y tratamiento es uno de los factores relacionados con mayor tasa de mortalidad y secuelas. Se describe la "reacción paradojal" como un deterioro sintomático de grado variable, durante el tratamiento efectivo de la tuberculosis. El aumento de la resistencia del Mycobacterium tuberculosis a fármacos observado en los últimos años genera mayor preocupación ante la aparición de una reacción paradojal durante el tratamiento. Se presenta el caso de un niño con meningitis tuberculosa que, luego de un mes de tratamiento, presentó empeoramiento clínico y nuevas lesiones en la tomografía y resonancia magnética nuclear de cerebro. Se excluyeron patologías asociadas, se verificó que la toma de medicamentos haya sido supervisada, y la sensibilidad del bacilo a fármacos antituberculosos de primera línea fue confirmada. El paciente no requirió cambios en el esquema de tratamiento antituberculoso y se administraron esteroides para el alivio sintomático. La reacción paradojal durante el tratamiento antituberculoso es infrecuente y debida a una reacción de hipersensibilidad entre el huésped y el bacilo tuberculoso. Cuando aparece, se debe asegurar la efectividad y el cumplimiento del tratamiento administrado. Palabras clave: tuberculosis extrapulmonar, meningitis tuberculosa, reacción paradojal. ABSTRACTThe central nervous system is one of the locations of extrapulmonary tuberculosis with worse prognosis. The delay in diagnosis and treatment is one of the factors associated with higher mortality and sequelae. The "paradoxical reaction" is described as a variable degree of symptomatic deterioration during the effective treatment of tuberculosis. The increased resistance of Mycobacterium tuberculosis to drugs observed in recent years generates greater concern about the emergence of a paradoxical reaction during treatment. The case of a child with tuberculous meningitis that after one month of treatment presented clinical worsening and new lesions in CT and MRI images of the brain is presented. Comorbidities were excluded, it was verified that taking drugs has been monitored, and the sensitivity of the bacillus to first- Reacción paradojal en meningitis tuberculosa. Presentación de un casoParadoxical reaction in tuberculous meningitis. A case report line antituberculosis drugs was confirmed. The patient required no change in the pattern of tuberculosis treatment and steroids were administered for symptomatic relief. The paradoxical reaction during antituberculosis treatment is rare and due to a hypersensitivity reaction between the host and the tuberculous bacillus. When it appears you must ensure the effectiveness and compliance of the treatment.

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Section: Discussionunclassified

“…Por este motivo, se emplean corticoides para el alivio sintomático (tal como fue tratado el paciente que presentamos) además de continuar con el tratamiento antituberculoso supervisado. 3,4,14,15 …”

Section: Discussionunclassified

Reacción paradojal en meningitis tuberculosa. Presentación de un caso

González

Ponte

2014

Arch Argent Pediat

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“…A paradoxical reaction was defined as the worsening of pre-existing tuberculous lesions or the appearance of new tuberculous lesions in patients whose clinical symptoms initially improved and had been on antituberculosis treatment for at least 10 days [2,3,11]. For the purpose of the calculation of "time of onset of paradoxical reaction" in the study participants only clinical deteriorations were considered from the time of initiation of anti-tuberculosis treatment; nonsymptomatic radiological worsening was defined either at the time of clinical deteriorations or at the predefined follow-up visit.…”

Section: Definition Of Paradoxical Reactionmentioning

confidence: 99%

“…The clinical or radiological deterioration associated with such a reaction may fallaciously suggest either a drug resistant state or treatment failure, and might even prompt to look for an alternative diagnosis [1][2][3]. The manifestations of paradoxical reaction, that have been described, are mostly derived from case reports and small case series.…”

Section: Introductionmentioning

confidence: 99%

Miliary Tuberculosis Mimicking Brain Metastasis from Renal Cell Carcinoma

Park

et al. 2018

J Neurocrit Care

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Background: Awareness about paradoxical reactions in tuberculous meningitis is crucial as a paradoxical reaction may lead to certain wrong conclusions (for example, an erroneous diagnosis, and a possibility of treatment failure, mycobacterial drug-resistance, drug toxicity, or presence of a malignancy). The present study was planned to evaluate the incidence and predictive factors of paradoxical reactions in light of clinical, cerebrospinal fluid, and neuroimaging characteristics. Methods: In this prospective cohort study, consecutive patients fulfilling the International Consensus criteria of tuberculous meningitis were included. Patients were subjected to clinical evaluation, cerebrospinal fluid evaluation, and neuroimaging. Patients were treated with anti-tuberculosis drugs along with corticosteroids. Patients were regularly followed up at 3 monthly intervals. At each follow up patients were evaluated clinically and repeat cerebrospinal fluid analysis was performed along with repeat neuroimaging. Disability assessment was done using Barthel index. Results: We enrolled 141 patients of tuberculous meningitis. Approximately one-third of patients (44/141; 31.2 %) developed a paradoxical reaction. Twenty-seven patients developed hydrocephalus, 26 developed tuberculomas, 12 developed optochiasmatic arachnoiditis and 4 patients had spinal arachnoiditis. In 41 patients (out of 44) cerebrospinal fluid paradoxically worsened (increase in cells and/or protein); 2 demonstrated a decrease in cells with polymorph predominance while in one it was normal. In 3 patients, paradoxical cerebrospinal fluid changes were not associated with neuroimaging changes. On multivariate analysis, predictors of paradoxical reaction were female gender (p = 0.013), HIV positivity (p = 0.01) and a shorter duration of illness (p = 0.049). Development of paradoxical reactions did not predict the disability status of the patients.Conclusions: Paradoxical reaction occurs in approximately one-third of patients with tuberculous meningitis. Female gender, concomitant HIV infection, and a shorter duration of illness were significant predictors. Paradoxical reactions did not adversely affect the outcome.

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“…Most lesions are observed at time of tuberculosis diagnosis, either meningeal or systemic, or soon after starting treatment (paradoxical reaction). They are present in 1% of patients with active tuberculosis and up to 28% of patients with tuberculous meningitis 4 . The inflammatory reaction observed in central nervous system tuberculosis has a strong predilection for basal parts of the brain, especially in interpeduncular, suprasellar and Sylvian cisterns, which can result in optochiasmatic arachnoiditis and tuberculoma 2 .…”

Section: Introductionmentioning

confidence: 99%

Optochiasmatic tuberculoma as the sole manifestation of late recurrent tuberculosis

Lima¹,

Aversa²,

Maranhão-Filho³

et al. 2012

Rev. Inst. Med. trop. S. Paulo

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SUMMARYBrain tuberculomas account for 10-20% of space occupying brain lesions in developing countries. Most lesions are observed at time of tuberculosis diagnosis or soon after starting treatment. We herein describe a 32 year-old patient with a 14-month history of headache and progressive visual loss. Her past medical history revealed pulmonary tuberculosis treated eight years before. A brain MRI showed a T1-and T2-weighted isointense contrast-enhancing lesion in the optic chiasm. A presumptive diagnosis of optochiasmatic tuberculoma was made and isoniazid, rifampin, pyrazinamide, and ethambutol were started. Despite treatment, the patient evolved to blindness. The prompt recognition of this condition is extremely important since the presence of optochiasmal enhancement is associated with blindness in patients with tuberculosis.

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Intracranial tuberculomas developing while on therapy for pulmonary tuberculosis

Cited by 103 publications

References 30 publications

Reacción paradojal en meningitis tuberculosa. Presentación de un caso

Reacción paradojal en meningitis tuberculosa. Presentación de un caso

Miliary Tuberculosis Mimicking Brain Metastasis from Renal Cell Carcinoma

Optochiasmatic tuberculoma as the sole manifestation of late recurrent tuberculosis

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