Neurological Worsening in a Child of Miliary Tuberculosis with Neuro-Tuberculosis on Anti Tubercular Treatment

Abstract

A seven and half year old male child presenting with pyrexia of unknown origin was diagnosed to be a case of miliary tuberculosis. Neuroimaging revealed multiple discrete ring as well as nodular enhancing lesions indicative of tuberculomas. After the initial response to ATT along with systemic steroids the child again presented with severe headache along with vomiting towards the end of intensive phase. Repeat neuroimaging showed appearance of new lesions with perilesional edema. Child was started again on systemic steroids and Streptomycin was added to the anti tubercular regimen, to which the child responded well.

High-risk and low prevalence disease: Cardiac sarcoidosis and some of its mimics

“…It was only after corticosteroids had been coprescribed with those three agents that he was able to tolerate antituberculous chemotherapy without experiencing relapse of CHF [55] . Transient paradoxical treatment-related worsening of symptoms and/ or signs of tuberculosis(also entitled “paradoxical upgrading reaction”) has also been documented in miliary tuberculosis with neurotuberculosis [56] , and in tuberculous lymphadenitis [57] , and is believed to be an excessive immune reaction to tuberculoproteins and other cell wall antigens of live or dead mycobacteria [57] .…”