Corticosteroid therapy for the management of paradoxical inflammatory reaction in patients with pulmonary tuberculosis

[Paradoxical tuberculosis reaction]

Paradoxical tuberculosis reaction is defined as the aggravation of lesions present at diagnosis or the development of new lesions under anti-tuberculosis treatment, after exclusion of other alternate causes. It affects 5 to 30% of tuberculosis patients, with a variable prevalence depending on the site of infection and the clinical background. The diagnosis of paradoxical reaction is one of elimination, and requires having ruled out therapeutic failure, notably linked to poor compliance and/or to the presence of mycobacterial antibiotic resistance. The severity of paradoxical tuberculosis reaction lies in its neurological impairment. Despite its clinical importance, the mechanisms involved remain poorly understood and its management is not consensual. Corticosteroids are the cornerstone in the medical management. The role of anti-TNF agents, currently proposed in cases of corticodependence or corticoresistance, remains to be properly defined.

Paradoxical Reaction to Antitubercular Treatment in a Case of Tuberculous Meningitis

Tuberculous meningitis (TBM) is a challenging disease to treat, as Mycobacterium tuberculosis infects the meninges, which are the outer membranes of the brain and the spinal cord. The majority of patients diagnosed with TBM acquire various other central nervous system complications, and as a result, treating the disease becomes a challenging task. A paradoxical reaction to the treatment may occur in the course of managing TBM. This case study describes a 20-year-old Southeast Asian female who was diagnosed and treated for TBM and subsequently developed a resurgence of the disease due to a paradoxical reaction.