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Paradoxical tuberculomas after completion of antituberculous treatment

Ira Shah1, Shilpa Borse

  • 1Pediatric TB Clinic, B. J. Wadia Hospital for Children, Mumbai, India.

Tropical Medicine and Health
|September 6, 2012
PubMed

Insights

Paradoxical reactions, a rare immune response to tuberculosis treatment, can manifest as intracranial tuberculomas even after completing antituberculous therapy (ATT). This study highlights two such cases in patients with tuberculous meningitis.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Immunology

Background:

  • Tuberculous meningitis (TBM) is a severe form of tuberculosis affecting the central nervous system.
  • Paradoxical reactions (PRs) during anti-tuberculous therapy (ATT) are characterized by the worsening of existing lesions or the appearance of new ones.
  • PRs are typically attributed to an exaggerated host immune response to Mycobacterium tuberculosis antigens during ATT initiation.

Observation:

  • Paradoxical reactions in TBM commonly present as intracranial tuberculomas.
  • These reactions usually occur within 14-270 days of starting ATT, predominantly during the intensive phase of chemotherapy.
  • A rare subset of PRs occurs after the completion of ATT.

Findings:

  • This report details two cases of tuberculous meningitis where patients developed intracranial tuberculomas after completing their full course of ATT.
  • These cases represent rare instances of paradoxical reactions occurring late in the treatment course, post-ATT completion.
  • The development of tuberculomas post-ATT completion suggests a persistent or delayed immune response.

Implications:

  • The findings suggest that prolonged or delayed immune-mediated inflammation can occur even after successful completion of ATT for TBM.
  • Clinicians should maintain a high index of suspicion for paradoxical reactions, including late-onset tuberculomas, in patients with a history of TBM.
  • Further research is needed to understand the mechanisms behind late-onset paradoxical reactions and optimize management strategies.
Keywords:
childrenparadoxical reactionstuberculomastuberculous meningitis

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