Paradoxical expansion of intracranial tuberculomas during chemotherapy

A patient from India with military lung tuberculosis who developed intracranial tuberculomas under treatment with tuberculostatics is described. Computed tomography (CT) scans of the brain showed a progress of tuberculomas despite effective tuberculostatic therapy and adjunctive corticosteroid treatment. This phenomenon, termed 'paradoxical response' has rarely been reported. Continuation of chemotherapy led to improvement of brain lesions and a recovery of miliary tuberculosis. When intracranial tuberculomas develop, therapy should be continued for longer than is customary for uncomplicated tuberculosis infections. The use of steroids to suppress a 'paradoxical response' is not proven.