Paradoxical Expansion of Cerebral Tuberculomas during Therapy for Pott's Spine

Malik, Ghaus M.; Mubarik, Muhammad Samee; Basu, J A; Kadla, Showkat Ahmad; Hussain, Tajamul; Rashid, Shakir

doi:10.1177/014107689608901113

Cited by 8 publications

(5 citation statements)

References 4 publications

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“…Including the two cases presented here, a total of 143 episodes of paradoxical response was found in the English literature, of which 122 episodes in 104 patients matched our definition (Table 1) [4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,…”

Section: Literature Reviewmentioning

confidence: 68%

“…Twenty-two percent of all episodes were complicated by residual functional deficits. Evaluation of the clinical spectrum of paradoxical response showed a high propensity for central nervous system involvement, described in 49% of all cases reported in the literature [4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,51,52,53,54]. Because the central nervous system is a highly compact and functionally demanding structure confined within the rigid skull bone, symptomatic neurological deterioration may occur with the enlargement or appearance of intracranial tuberculomas during paradoxical response.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Spectrum of Paradoxical Deterioration During Antituberculosis Therapy in Non-HIV-Infected Patients

Cheng

Lee

et al. 2002

European Journal of Clinical Microbiology & Infectious Dise

305

233

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Paradoxical deterioration during antituberculosis therapy, defined as the clinical or radiological worsening of pre-existing tuberculous lesions or the development of new lesions in a patient who initially improves, remains a diagnostic dilemma. Although different clinical presentations of paradoxical response have been described, a systematic analysis of the entity in non-HIV-infected patients is lacking. Reported here are two cases of paradoxical deterioration in which sequential changes in lymphocyte counts and tuberculin skin test results are emphasized. In addition, 120 episodes of paradoxical response after antituberculosis treatment were reviewed. Of the total 122 episodes, 101 (82.8%) were associated with extrapulmonary tuberculosis. The median time from commencement of treatment to paradoxical deterioration was 60 days. The median time to onset of central nervous system manifestations (63 days) was longer than the time to onset of manifestations at other sites (56 days) ( P=0.02). Development of new lesions in anatomical sites other than those observed at initial presentation was observed in 31 (25.4%) episodes. A surge in the lymphocyte count, accompanied by an exaggerated tuberculin skin reaction, was observed in our patients during the paradoxical deterioration, analogous to the findings in HIV-positive patients. Treatment of the paradoxical response included surgical intervention (60.7%) and administration of steroids (39.3%). The use of steroids appeared to be safe in this series, as 95% of the Mycobacterium tuberculosis isolates were susceptible to first-line antituberculosis therapy.

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Section: Literature Reviewmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Clinical Spectrum of Paradoxical Deterioration During Antituberculosis Therapy in Non-HIV-Infected Patients

Cheng

Lee

et al. 2002

European Journal of Clinical Microbiology & Infectious Dise

305

233

View full text Add to dashboard Cite

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“…Enlargement of lymph nodes (which do not have the barrier like blood brain barrier) in pa ents on an -tubercular therapy further goes against the hypothesis. Paradoxical response is possibly due to a Type IV hypersensi vity reac on developing within the ini al lesion and resul ng in cerebral vasculi s, infarc on, and edema 11,12,13 . Paradoxical reac ons occur due to complex interplay between host's immune response and the direct eff ect of mycobacterial an gens 14,15,16 .…”

Section: Discussionmentioning

confidence: 99%

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

Arora

Narang

Dhillon

2016

J. Nepal Paedtr. Soc.

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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.

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“…Si la activación ocurre en un foco microscópico del sistema nervioso central aparecerán tuberculomas 4 y si ocurre en un tuberculoma, este puede aumentar su tamaño, debido al desarrollo de focos presentes antes del inicio de la terapia que por disturbios inmunológicos desarrollaron la infección focal en lugar de controlarla. [5][6][7] Cheng y col. 8 en una revisión sistemática de la literatura en Medline de 1966 a 2001 encontraron reportes de 143 casos de reacción paradójica al tratamiento TBC en pacientes sin VIH. La relación de hombre/ mujer fue de 1,2/1.…”

Section: Discussionunclassified

Leucemia linfoide aguda y mal de pott: Respuesta paradójica al tratamiento antitbc

Gómez¹,

Vargas²,

Alfonso³

et al. 2015

Repert. Med. Cir.

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ResumenHombre de 58 años con diagnóstico de leucemia linfoide aguda llevado a trasplante de progenitores de sangre periférica de donante intrafamiliar. Requirió manejo inmunosupresor por presencia de enfermedad injerto contra huésped aguda y crónica. Consultó por dolor lumbar severo y en los exámenes se encontraron lesiones compatibles con espondilodiscitis L4-L5 y colecciones paravertebrales. Con sospecha de tuberculosis se inició tratamiento empírico, la evolución clínica inicial fue tórpida por persistencia de síntomas y compromiso neurológico progresivo, por lo cual se sospechó presencia de micobacterias atípicas vs resistentes. Se logró aislamiento de Mycobacterium tuberculosis susceptible a la terapia instaurada. Se continuó esquema de tratamiento TBC con evolución clínica a la mejoría. Se interpretó como reacción paradójica a la terapia, pero con presencia de lesión renal en la que se confirmó recaída de la enfermedad hematológica.Palabras clave: tuberculosis, Mycobacterium tuberculosis, trasplante de médula ósea, síndrome inflamatorio de reconstitución inmune. Abreviaturas: TBC, tuberculosis. AbstractWe report the case of a 58 year-old male patient diagnosed with acute lymphoid leukemia who received a peripheral blood stem cell transplant from a family member. He required immunosuppressive management for developing acute and chronic graft-versus-host disease. He presented with severe back pain. Imaging showed spondylodiscitis L4/L5 and paravertebral fluid collections. Empirical anti-TB therapy was instituted for suspicion of tuberculosis. The initial phase was torpid due to persistent symptoms and progressive neurologic compromise, thus, the presence of atypical vs resistant mycobacteria was suspected. Initiated-therapy-susceptible Mycobacterium tuberculosis was isolated. The anti-TB therapy regimen was continued with improvement in his clinical state. It was interpreted as a paradoxical response to therapy, associated with the presence of a renal lesion in which a relapse of the hematologic condition was confirmed.

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Paradoxical Expansion of Cerebral Tuberculomas during Therapy for Pott's Spine

Cited by 8 publications

References 4 publications

Clinical Spectrum of Paradoxical Deterioration During Antituberculosis Therapy in Non-HIV-Infected Patients

Clinical Spectrum of Paradoxical Deterioration During Antituberculosis Therapy in Non-HIV-Infected Patients

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

Leucemia linfoide aguda y mal de pott: Respuesta paradójica al tratamiento antitbc

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