Cyclophosphamide therapy as an adjunct in refractory post-tubercular arachnoiditis

Area of Science:

• Neurology
• Immunology
• Infectious Diseases

Background:

• Post-tubercular arachnoiditis lacks effective treatments.
• Refractory cases often lead to severe neurological deficits like paraparesis and vision loss.

Purpose of the Study:

• To investigate the efficacy and safety of cyclophosphamide as an adjuvant therapy.
• To evaluate cyclophosphamide in patients with post-tubercular arachnoiditis refractory to corticosteroids and anti-tubercular therapy (ATT).

Main Methods:

• Retrospective case series of 4 patients with refractory post-TB arachnoiditis.
• Patients received intravenous cyclophosphamide (500 mg/m² monthly for 4 months) alongside ATT and corticosteroids.
• Clinical and radiological assessments were performed before and after treatment.

Main Results:

• Three out of four patients achieved independent ambulation.
• Significant clinical and radiological improvements were observed in all patients.
• Cyclophosphamide was administered as an adjuvant therapy.

Conclusions:

• Cyclophosphamide therapy may be effective for refractory post-TB arachnoiditis.
• Further randomized controlled trials are needed to confirm safety and efficacy.
• Adjuvant cyclophosphamide offers a potential treatment avenue for severe cases.