• Medicine · Oct 2020

    Review Case Reports

    Tumor necrosis factor antagonists for paradoxical inflammatory reactions in the central nervous system tuberculosis: Case report and review.

    • Miguel Santin, Cristina Escrich, Carles Majòs, Mariona Llaberia, Maria D Grijota, and Imma Grau.
    • Tuberculosis Unit, Service of Infectious Diseases, Bellvitge University Hospital-Bellvitge Institute for Biomedical Research (IDIBELL).
    • Medicine (Baltimore). 2020 Oct 23; 99 (43): e22626.

    RationaleParadoxical reaction/immune reconstitution inflammatory syndrome is common in patients with central nervous system tuberculosis. Management relies on high-dose corticosteroids and surgery when feasible.Patient ConcernWe describe 2 cases of HIV-negative patients with corticosteroid-refractory paradoxical reactions of central nervous system tuberculosis.DiagnosesThe 2 patients experienced clinical impairment shortly after starting therapy for TB, and magnetic resonance imaging showed the presence of tuberculomas, leading to the diagnosis of a paradoxical reaction.InterventionsWe added infliximab, an anti-tumor necrosis factor (TNF)-alpha monoclonal antibody, to the dexamethasone.OutcomesBoth patients had favorable outcomes, 1 achieving full recovery but 1 suffering neurologic sequelae.LessonsClinicians should be aware of the risk of paradoxical reactions/immune reconstitution inflammatory syndrome when treating patients with tuberculosis of the central nervous system and should consider the prompt anti-TNF-α agents in cases not responding to corticosteroids.

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