[Paradoxical reaction in tuberculous meningitis: a case report]

Area of Science:

• Neurology
• Infectious Diseases
• Pediatrics

Background:

• Central nervous system tuberculosis (tuberculous meningitis) has a poor prognosis.
• Delayed diagnosis and treatment of tuberculous meningitis increase mortality and sequelae.
• Paradoxical reactions, a worsening of symptoms during effective tuberculosis treatment, are a growing concern due to drug resistance.

Observation:

• A child with tuberculous meningitis presented with clinical deterioration and new brain lesions on imaging after one month of treatment.
• Comorbidities were ruled out, treatment adherence was confirmed, and Mycobacterium tuberculosis sensitivity to first-line drugs was verified.
• The patient's condition improved with steroid administration for symptomatic relief without altering the tuberculosis treatment regimen.

Findings:

• The case illustrates a rare paradoxical reaction in pediatric tuberculous meningitis.
• This reaction is attributed to a host-pathogen hypersensitivity response.
• Effective tuberculosis treatment and compliance are crucial, even when paradoxical reactions occur.

Implications:

• Early recognition and management of paradoxical reactions are vital for improving outcomes in tuberculous meningitis.
• Steroids can be beneficial for symptomatic management of paradoxical reactions.
• Continued vigilance for paradoxical reactions is necessary in the era of increasing drug-resistant tuberculosis.