ArticleIDCases2025
Recurrent paradoxical reactions as non-communicating hydrocephalus and basal meningitis in a non-HIV patient with tuberculous meningitis and tuberculoma.
Article in IDCases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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2 authors.
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Abstract
Background: Tuberculosis meningitisis the most devastating form of Tuberculosis, causing high mortality or disability. Paradoxical neuro-inflammatory reactions, which occur despite appropriate anti-TB chemotherapy, may reflect the host response to dead and dying bacterial. Case report: We report a case involving paradoxical reaction, effectively managed with emergent external ventricular drainage (EVD). The patient, a healthy 30-year-old Burmese woman, was diagnosed with disseminated tuberculosis involving pulmonary disease, vertebral osteomyelitis, and meningitis. Treatment included isoniazid (INH) 300 mg/day, rifampicin (RFP) 450 mg/day, ethambutol (EB) 750 mg/day, pyrazinamide (PZA) 1250 mg/day, levofloxacin (LVFX) 500 mg/day, and Dexamethasone (DEX) 0.4 mg/kg/day. A week after treatment initiation, she experienced the a paradoxical reaction but found relief with symptomatic treatment. Due to susceptibility of tuberculosis, we transitioned her to INH+RFP+LVFX, and DEXA was discontinued after two months. On day 66, she was readmitted with worsening symptoms and was diagnosed with a second paradoxical reaction and hydrocephalus. Neurosurgery inserted an EVD tube and resumed DEXA. The patient showed significant improvement, and the EVD was subsequently removed. DEXA was stopped after 4 months.There was no recurrence in one year. Conclusion: During the treatment of TBM, a paradoxical reaction can occur at any time. Therefore, we recommend the necessity of collaborating with a neurosurgeon to facilitate emergency EVD drainage for the management of hydrocephalus.
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