Abstract Details

Title Paradoxical reaction in non-HIV patients with CNS tuberculosis: what, when and how?

Topic Infectious Disease

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-030

Objective To describe paradoxical reaction to antituberculous treatment in four cases of tuberculous meningitis.

Background Paradoxical reaction refers to clinical deterioration weeks to months after adequate antituberculosis treatment. Although the physiopathology is not entirely known, in the HIV patient it has been related to a context of immunological recovery associated with antiretroviral treatment (IRIS), however, in the non-HIV patient, these mechanisms are still unknown.

Design/Methods Cases will be discussed. All patients signed an IC and were described without identifiers.

Results We report 4 cases, of which 50% had a disseminated form, the diagnosis was established in 75% of the cases with culture and 50% with PCR, isolating in 3 patients (75%) Mycobacterium Bovis. The most frequent symptoms were: 3 (75%) headache, 3 (75%) seizures, and 2 (50%) hemiparesis, highlighting that 75% had 2 or more symptoms. The average presentation of the paradoxical response after the initiation of antituberculous drugs was nine weeks (3 weeks-3.5 months), only 25% of the cases occurred during the first month. Regarding the imaging findings, 100% had some degree of pachymeningitis at presentation, of which 50% evolved infarction, 25% hydrocephalus and 25% developed tuberculoma. In 50% of the cases, it was necessary to use cyclophosphamide around the fourth month. There was a case of death that presented a disseminated form by Mycobacterium Bovis and hydrocephalus.

Conclusions Some cases are refractory to steroids and need the use of other immunomodulators to stop the inflammatory response. Timing and type of immunosuppressive add-on treatment will be discussed.

Authors/Disclosures
Rogelio Dominguez-Moreno, MD (Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran) PRESENTER	Dr. Dominguez-Moreno has nothing to disclose.
Carlos Cantu, MD, MSc (Hospital Angeles Del Pedregal)	Dr. Cantu has nothing to disclose.
Maria Alejandra Gonzalez Duarte, MD, FAAN (NYU Dysautonomia Center)	Dr. Gonzalez Duarte has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alnylam. Dr. Gonzalez Duarte has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astra Zeneca. Dr. Gonzalez Duarte has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alnylam . The institution of Dr. Gonzalez Duarte has received research support from Pfizer.

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