Late-onset paradoxical reactions 10 years after treatment for tuberculous meningitis in an HIV-negative patient: a case report
Abstract Background Although paradoxical reactions (PRs) to anti-tuberculosis (anti-TB) therapy during treatment are well-established occurrences, PRs presenting as a new lesion after the completion of treatment are extremely rare, and little is known about the management of such cases, particularly...
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| Format: | Article |
| Language: | English |
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BMC
2018-07-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | http://link.springer.com/article/10.1186/s12879-018-3229-z |
| _version_ | 1818681346055208960 |
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| author | Akira Machida Tasuku Ishihara Eiichiro Amano Shinichi Otsu |
| author_facet | Akira Machida Tasuku Ishihara Eiichiro Amano Shinichi Otsu |
| author_sort | Akira Machida |
| collection | DOAJ |
| description | Abstract Background Although paradoxical reactions (PRs) to anti-tuberculosis (anti-TB) therapy during treatment are well-established occurrences, PRs presenting as a new lesion after the completion of treatment are extremely rare, and little is known about the management of such cases, particularly of central nervous system (CNS) tuberculosis. Case presentation A 27-year-old female, with a past medical history of tuberculous meningitis 10 years ago and who completed the anti-TB treatment with asymptomatic remnant tuberculomas in the basal cistern, was admitted to our hospital because of a headache and the worsening of pre-existing visual disturbance. Contrast-enhanced T1-weighted brain magnetic resonance imaging (MRI) revealed new tuberculomas in the left sylvian fissure with a diffuse low signal around it. Because repeated polymerase chain reaction and Mycobacterium tuberculosis culture presented negative results and the patient had no laboratory data suggestive of a relapse of tuberculous meningitis, she was diagnosed with late-onset post-treatment PRs and treated with oral corticosteroids, tapered off over 1 year. Eventually, the symptoms were relieved, and the tuberculomas disappeared. Conclusions Clinicians should consider the possibility of PRs long after the completion of tuberculous meningitis treatment. Hence, a precise MRI-based examination is imperative for the follow-up of CNS tuberculosis, and the unnecessary administration of anti-TB drugs should be avoided. The use of corticosteroids as a treatment option for post-treatment PRs is seemingly safe when the isolated M. tuberculosis is sensitive to the first-line anti-TB therapy. |
| first_indexed | 2024-12-17T10:01:29Z |
| format | Article |
| id | doaj.art-956c0a25db1641c0a6b7cd93dd0de876 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-17T10:01:29Z |
| publishDate | 2018-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-956c0a25db1641c0a6b7cd93dd0de8762022-12-21T21:53:17ZengBMCBMC Infectious Diseases1471-23342018-07-011811510.1186/s12879-018-3229-zLate-onset paradoxical reactions 10 years after treatment for tuberculous meningitis in an HIV-negative patient: a case reportAkira Machida0Tasuku Ishihara1Eiichiro Amano2Shinichi Otsu3Department of Neurology, Tsuchiura Kyodo General HospitalDepartment of Neurology, Tsuchiura Kyodo General HospitalDepartment of Neurology, Tsuchiura Kyodo General HospitalDepartment of Neurology, Tsuchiura Kyodo General HospitalAbstract Background Although paradoxical reactions (PRs) to anti-tuberculosis (anti-TB) therapy during treatment are well-established occurrences, PRs presenting as a new lesion after the completion of treatment are extremely rare, and little is known about the management of such cases, particularly of central nervous system (CNS) tuberculosis. Case presentation A 27-year-old female, with a past medical history of tuberculous meningitis 10 years ago and who completed the anti-TB treatment with asymptomatic remnant tuberculomas in the basal cistern, was admitted to our hospital because of a headache and the worsening of pre-existing visual disturbance. Contrast-enhanced T1-weighted brain magnetic resonance imaging (MRI) revealed new tuberculomas in the left sylvian fissure with a diffuse low signal around it. Because repeated polymerase chain reaction and Mycobacterium tuberculosis culture presented negative results and the patient had no laboratory data suggestive of a relapse of tuberculous meningitis, she was diagnosed with late-onset post-treatment PRs and treated with oral corticosteroids, tapered off over 1 year. Eventually, the symptoms were relieved, and the tuberculomas disappeared. Conclusions Clinicians should consider the possibility of PRs long after the completion of tuberculous meningitis treatment. Hence, a precise MRI-based examination is imperative for the follow-up of CNS tuberculosis, and the unnecessary administration of anti-TB drugs should be avoided. The use of corticosteroids as a treatment option for post-treatment PRs is seemingly safe when the isolated M. tuberculosis is sensitive to the first-line anti-TB therapy.http://link.springer.com/article/10.1186/s12879-018-3229-zTuberculous meningitisParadoxical reactionsTuberculoma |
| spellingShingle | Akira Machida Tasuku Ishihara Eiichiro Amano Shinichi Otsu Late-onset paradoxical reactions 10 years after treatment for tuberculous meningitis in an HIV-negative patient: a case report BMC Infectious Diseases Tuberculous meningitis Paradoxical reactions Tuberculoma |
| title | Late-onset paradoxical reactions 10 years after treatment for tuberculous meningitis in an HIV-negative patient: a case report |
| title_full | Late-onset paradoxical reactions 10 years after treatment for tuberculous meningitis in an HIV-negative patient: a case report |
| title_fullStr | Late-onset paradoxical reactions 10 years after treatment for tuberculous meningitis in an HIV-negative patient: a case report |
| title_full_unstemmed | Late-onset paradoxical reactions 10 years after treatment for tuberculous meningitis in an HIV-negative patient: a case report |
| title_short | Late-onset paradoxical reactions 10 years after treatment for tuberculous meningitis in an HIV-negative patient: a case report |
| title_sort | late onset paradoxical reactions 10 years after treatment for tuberculous meningitis in an hiv negative patient a case report |
| topic | Tuberculous meningitis Paradoxical reactions Tuberculoma |
| url | http://link.springer.com/article/10.1186/s12879-018-3229-z |
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