Intractable intracranial tuberculous infection responsive to thalidomide: Report of four cases
Date
2006
Authors
Schoeman J.F.
Fieggen G.
Seller N.
Mendelson M.
Hartzenberg B.
Journal Title
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Abstract
Paradoxical enlargement and development of new intracranial tuberculomas and tuberculous brain abscesses on adequate antituberculosis treatment are well recognized and supposedly cytokine mediated. These lesions are often unresponsive to conventional antituberculosis treatment, corticosteroids, and surgery. We therefore assessed the effect of adjunctive thalidomide, a tumor necrosis factor α-modulating drug, in intractable intracranial tuberculosis that did not respond to standard medical and surgical therapy. Four consecutive children (three children with bacteriologic proof and one child with clinical evidence of intracranial tuberculosis) were studied. Three patients each had a giant tuberculous abscess, and the fourth had chronic basal arachnoiditis with progressive loss of vision. Three of the four patients had relentless neurologic deterioration, and all showed disease progression on neuroimaging despite full medical and appropriate surgical treatment. Marked clinical and neuroradiologic improvement occurred after thalidomide was added to the antituberculosis treatment regimen of these four patients. Adjunctive thalidomide might have a role in the management of intractable intracranial tuberculosis and needs further investigation in this regard.
Description
Keywords
amikacin, ciprofloxacin, corticosteroid, ethionamide, isoniazid, prednisone, pyrazinamide, rifampicin, thalidomide, tumor necrosis factor alpha, absence of side effects, adjuvant therapy, arachnoiditis, article, bacteriology, brain abscess, brain infection, brain surgery, clinical article, clinical feature, computer assisted tomography, deterioration, disease course, drug response, extrapulmonary tuberculosis, female, human, male, neuroradiology, nuclear magnetic resonance imaging, preschool child, priority journal, treatment failure, visual impairment, Arachnoiditis, Blindness, Brain, Child, Child, Preschool, Disease Progression, Drug Therapy, Combination, Female, Follow-Up Studies, Humans, Immunosuppressive Agents, Infant, Magnetic Resonance Imaging, Male, Thalidomide, Treatment Outcome, Tuberculoma, Intracranial
Citation
Journal of Child Neurology
21
4
21
4