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Perplexing paradoxical reactions: navigating the complexity of protracted tuberculosis meningitis-a case report
Megan S Gooding1, Dima A Hammoud2, Brian Epling3
1Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, United States.
Paradoxical reactions (PRs) complicate tuberculous meningitis (TBM) treatment, often requiring drug dose adjustments and intensified regimens. Biomarker analysis reveals elevated inflammatory markers in PRs, aiding future diagnostics and treatment strategies for TBM.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Tuberculous meningitis (TBM) presents significant mortality and morbidity.
- Paradoxical reactions (PRs) pose therapeutic challenges in TBM management.
Observation:
- Four TBM patients experiencing PRs were studied within a larger TB cohort.
- Participants presented with fever, headache, neurological deficits, and fatigue.
- PRs occurred a median of 37 days after initiating standard anti-tuberculosis therapy (ATT) and corticosteroids.
Findings:
- Patients with PRs exhibited low drug concentrations, necessitating dose optimization and regimen intensification.
- PRs were associated with recrudescent TBM symptoms, even after corticosteroid taper.
- Biomarker analysis indicated elevated plasma interferon-gamma and ferritin levels in PRs.
- T-cell activation and increased inflammatory biomarkers in cerebrospinal fluid (CSF) were observed during PRs.
Implications:
- These detailed TBM cases offer insights into the pathogenesis of PRs.
- Findings may contribute to developing improved diagnostics for TBM-related PRs.
- Understanding PR pathogenesis can guide future treatment strategies for TBM.
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