Tubercular meningitis with therapeutic paradox

Anil Kumar KH, Basavaraja GV, Govindraj M
4.552 754


Tubercular meningitis is not so uncommonly associated with clinical deterioration while on treatment, which is observed 2-3months after starting the treatment, sometimes upto 18 months. A 12 year old boy presented with fever and cough of 1 week duration, evaluated and diagnosed to have disseminated tuberculosis. Anti-tubercular therapy was started. While on treatment child was apparently normal for about 2 months and then developed signs of meningo-encephalitis. On evaluation with MRI imaging, found to have new onset multiple subcentimetric ring enhancing lesions in both cerebral hemispheres suggestive of tuberculomas. This is due to improved delayed type of hypersensitivity observed after starting treatment for active tubercular infection. This condition responds well to steroids and does not warrant change of drug regimen.


Tubercular meningitis, therapeutic paradox

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