Possible role of adjunctive thalidomide therapy in the resolution of a massive intracranial tuberculous abcess
Date
2001
Authors
Schoeman J.F.
Ravenscroft A.
Hartzenberg H.B.
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Abstract
We present the case of a young child who developed a massive tuberculous abscess of the posterior fossa while being treated for pulmonary tuberculosis. Clinical improvement after surgical excision of the abscess was followed by recurrence of symptoms of acutely raised intracranial pressure on standard antituberculosis and corticosteroid therapy. Magnetic resonance (MR) imaging of the brain showed that a multiloculated abscess had developed anterior to the excision site of the original abscess. The recurring abscess was partly excised and drained but could not be removed completely because of its proximity to the brain stem. Thalidomide, a potent inhibitor of tumour necrosis factor alpha (TNF-α), was added to the treatment regimen and resulted in marked clinical improvement with resolution of the abscess within 4 months. The remaining CT lesion had the appearance of a small granuloma. Both the clinical and the radiological response was maintained after 1 year of antituberculosis treatment.
Description
Keywords
corticosteroid, ethambutol, isoniazid, prednisone, pyrazinamide, rifampicin, thalidomide, tuberculin, abscess drainage, article, brain abscess, brain fourth ventricle, brain ventricle peritoneum shunt, case report, computer assisted tomography, consciousness disorder, craniotomy, decerebration, decompression surgery, drug effect, fever, granuloma, human, hydrocephalus, hyperreflexia, infant, intracranial pressure, lung tuberculosis, male, mydriasis, nuclear magnetic resonance imaging, papilledema, posterior fossa, postoperative period, priority journal, recurrent disease, surgical drainage, tuberculin test, tuberculosis, vomiting, Antitubercular Agents, Combined Modality Therapy, Drug Therapy, Combination, Humans, Infant, Magnetic Resonance Imaging, Male, Recurrence, Reoperation, Thalidomide, Tuberculoma, Intracranial, Tumor Necrosis Factor-alpha
Citation
Child's Nervous System
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6
17
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