Paradoxical Expansion of Intracranial Tuberculomas During Chemotherapy

Bouchez, B; Arnott, Gareth; Colover, Jack

doi:10.1016/s0140-6736(84)92950-7

Cited by 17 publications

(9 citation statements)

References 6 publications

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“…PCR can remain positive for a long period (18). The finding of concomitant increase in ALC and conversion of the tuberculin skin test in our patients during paradoxical deterioration concurred with the observation in a previous reports who demonstrated a conversion of the tuberculin skin test in five HIV-negative patients during paradoxical deterioration (3,(19)(20)(21).…”

Section: Discussionsupporting

confidence: 93%

Paradoxical reactions during Antituberculosis therapy - A single-center prospective analysis

Hammi

Zemed

Bouti

et al. 2015

IJMS

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Background: Paradoxical reactions during anti-TB treatment represent a real challenge to pneumo-phthisiologists and require high index of suspicion. It has been suggested that this reaction during appropriate treatment is common and severe in HIVnegative individuals. Our objective was to determine the frequency of paradoxical reactions and their associated features. Method : A prospective study was undertaken in a population of HIV-TB+ patients to determine the frequency of paradoxical reactions and their associated features. Results: Paradoxical reactions occurred in 1.5% of all our hospital's TB patients. Conclusion : Paradoxical reactions during anti-TB treatment is common in HIV-uninfected individuals and must be considered after careful exclusion of medication non-adherence, other infections, development of resistance, and other similar conditions.

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Section: Discussionsupporting

confidence: 93%

Paradoxical reactions during Antituberculosis therapy - A single-center prospective analysis

Hammi

Zemed

Bouti

et al. 2015

IJMS

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“…The other likely explanation for the enlargement of old tuberculomas or appearance of new tuberculomas (or abscesses) is interplay between the host immune response and direct effects of mycobacterial products [1, 6, 9, 11, 15]. Active tuberculosis can result in depression of the delayed hypersensitivity response.…”

Section: Discussionmentioning

confidence: 99%

“…Unlike pulmonary tuberculosis, the paradoxical progression of intracranial tuberculomas during the treatment of neurotuberculosis has been recognized as a rare response to antitubercular chemotherapy. In the literature, more than 41 cases have been reported worldwide [1,4,5,6,7,8,9,10,11,12,13,14,15]. We encountered 10 children under 18 years of age, who demonstrated a paradoxical response to antitubercular therapy, where tuberculoma either increased in size or developed during the course of chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

Paradoxical Response to Chemotherapy in Neurotuberculosis

Kumar¹,

Prakash

Jha

2006

Pediatr Neurosurg

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Objective: Our objective was to investigate the paradoxical response and the factors responsible for such an uncommon (but known) response to chemotherapy in neurotuberculosis. Material and Methods: Ten children with intracranial tuberculomas/neurotuberculosis were retrospectively studied, who were on regular antituberculous chemotherapy. Any deterioration of the neurological condition, increase in the size of the lesion or appearance of new lesions was studied clinically and radiologically during the follow-up period. Results: An atypical response to chemotherapy was observed from 3 weeks to 1 year of chemotherapy. Four of the 10 children, who were receiving chemotherapy for either posttubercular meningitis (TBM), hydrocephalus (2) or TBM (2), developed multiple granulomas in 3 and hydrocephalus in 1 case. The remaining 6 children who were diagnosed to have granulomas at their presentation deteriorated at the follow-up despite regular chemotherapy. CT scans were repeated in 7 of 10 cases at the time of neurological deterioration, out of which 5 children showed appearance of new granulomas or abscess(es) and 2 showed an increase in the size of their preexisting granulomas. One patient with faintly enhancing granulomas in the posterior fossa responded to an additional use of steroids. The remaining 9 patients required surgical intervention on account of their neurological deterioration. Conclusions: (1) Paradoxical responses to intracranial tuberculoma/neurotuberculosis can occur at any time even up to 1 year during chemotherapy despite a regular standard antitubercular treatment. (2) New granuloma(s) or abscess(es) may appear in children receiving chemotherapy for TBM during the follow-up. (3) Hydrocephalus may also appear despite a regular chemotherapy in treated TBM cases. (4) Immature faintly enhancing tuberculomas have a more likely chance of resolution with antituberculous chemotherapy and glucocorticoids, while a well-formed and probably large-sized (>3 cm) granuloma may have a risk of paradoxical enlargement.

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“…Com relação ao mecanismo de formação dos tuberculomas intracranianos, ainda há controvérsia [7][8][9][10] . Acredita-se que a expansão dos tuberculomas tenha uma base imunológica.…”

Section: Fig 3 Ressonância Magnética Do Crânio Após Administração Deunclassified

“…6 descreveram 30 casos de tuberculomas intracranianos; destes, 77% apresentaram meningite tuberculosa prévia e desenvolveram tuberculomas intracranianos na vigência de tratamento tuberculostático e da melhora do quadro pulmonar. Outros autores corroboram esta afirmação, descrevendo casos semelhantes 2,[7][8][9][10] . Os tuberculomas podem ser intraparenquimatosos ou meníngeos.…”

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Múltiplos tuberculomas intracerebrais na vigência de terapia específica para tuberculose pulmonar: a propósito de um caso

Pimentel

Alves²,

Novis

et al. 2000

Arq. Neuro-Psiquiatr.

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RESUMO -A forma clássica de apresentação da neurotuberculose é a meningite. Os tuberculomas cerebrais são formas raras de neurotuberculose e resultam da disseminação hematogênica de focos distantes de infecção pelo Mycobacterium tuberculosis. Aproximadamente 1% dos pacientes com tuberculose do sistema nervoso central desenvolve tuberculomas intracranianos, poucas semanas ou meses após o início da quimioterapia tuberculostática. A involução das lesões é lenta e não necessariamente significa resistência medicamentosa ou falta de aderência ao tratamento. Descrevemos o caso, diagnosticado e tratado na 25ª Enfermaria da Santa Casa da Misericórdia do Rio de Janeiro, de um paciente imunocompetente que apresentou meningite e tuberculomas múltiplos do sistema nervoso central, durante o tratamento específico de tuberculose miliar. A literatura é revisada e o diagnóstico, terapêutica e possíveis mecanismos imunológicos são discutidos. PALAVRAS-CHAVE: tuberculoma, tuberculose miliar, quimioterapia tuberculostática. Intracranial tuberculomas developing during treatment of pulmonary tuberculosis: case reportABSTRACT -The classical presentation of neurotuberculosis is meningitis. Intracranial tuberculomas are a rare manifestation of neurotuberculosis and are due to hematogenous dissemination of distant focuses of Mycobacterium tuberculosis infection. Around 1% of patients with central nervous system tuberculosis develop intracranial tuberculomas some weeks or months after the beginning of the specific treatment with tuberculostatic chemotherapy. The involution of the lesions is slow and does not mean drug resistance nor lack of adequate treatment. We describe the case, diagnosed and treated at the 25 th Infirmary of Santa Casa da Misericórdia do Rio de Janeiro, of an immunocompetent male patient who developed meningitis and multiple intracranial tuberculomas during the specific treatment of miliary tuberculosis. The literature is revised and the diagnosis, treatment and possible immunological mechanisms are discussed.

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Paradoxical Expansion of Intracranial Tuberculomas During Chemotherapy

Cited by 17 publications

References 6 publications

Paradoxical reactions during Antituberculosis therapy - A single-center prospective analysis

Paradoxical reactions during Antituberculosis therapy - A single-center prospective analysis

Paradoxical Response to Chemotherapy in Neurotuberculosis

Múltiplos tuberculomas intracerebrais na vigência de terapia específica para tuberculose pulmonar: a propósito de um caso

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