Paradoxical manifestations during tuberculous meningitis treatment among HIV-negative patients: a retrospective descriptive study and literature review

Background Tuberculous meningitis (TBM) is the most frequent, severe, and disabling form of central nervous system (CNS) tuberculosis (TB). TBM paradoxical manifestations are characterized by clinical or paraclinical worsening after 1 month of effective anti-TB treatment in patients who initially re...

Full description

Saved in:
Bibliographic Details
Published in:Neurological sciences 2022-04, Vol.43 (4), p.2699-2708
Main Authors: Domínguez-Moreno, Rogelio, García-Grimshaw, Miguel, Medina-Julio, David, Cantú-Brito, Carlos, González-Duarte, Alejandra
Format: Article
Language:English
Subjects:
Adult
Antitubercular Agents - therapeutic use
Central nervous system
Cerebrospinal fluid
Corticosteroids
Cyclophosphamide
Female
HIV
HIV Infections - complications
HIV Infections - drug therapy
Human immunodeficiency virus
Humans
Hydrocephalus
Intravenous administration
Literature reviews
Male
Medicine
Medicine & Public Health
Meningitis
Middle Aged
Mycobacterium tuberculosis
Neurology
Neuroradiology
Neurosciences
Neurosurgery
Original Article
Patients
Psychiatry
Retrospective Studies
Steroid hormones
Steroids
Tuberculoma
Tuberculosis
Tuberculosis, Meningeal - cerebrospinal fluid
Tuberculosis, Meningeal - complications
Tuberculosis, Meningeal - drug therapy
Vascular diseases
Young Adult
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background Tuberculous meningitis (TBM) is the most frequent, severe, and disabling form of central nervous system (CNS) tuberculosis (TB). TBM paradoxical manifestations are characterized by clinical or paraclinical worsening after 1 month of effective anti-TB treatment in patients who initially responded to treatment despite the use of adjunctive corticosteroids. Methods Retrospective descriptive study of consecutive HIV-negative adult patients (≥ 18 years) with definitive TBM who developed a paradoxical manifestation following anti-TB in a tertiary-care hospital in Mexico from 2009 to 2019; we also conducted a literature review of published cases/series of paradoxical manifestations in HIV-negative patients from 1980 to 2020. Results We detected 84 cases of definitive TBM; 55 (68.7%) HIV-negative patients and 29 (36.3%) HIV-infected patients. Among HIV-negative patients, four (7.3%), three female and one male (19–49 years old), developed a paradoxical manifestation within 4–14 weeks following treatment initiation despite receiving adequate corticosteroid doses; Mycobacterium bovis was isolated from the cerebrospinal fluid of three cases and Mycobacterium tuberculosis in one more. Two patients developed vasculopathy-related cerebral infarctions, one severe basilar meningitis, and hydrocephalus, one more a tuberculoma. Two were treated with intravenous cyclophosphamide, and two with steroids. One of the patients treated with steroids died; patients who received cyclophosphamide had a good clinical response. Conclusions This case series illustrates the diverse clinical/radiologic paradoxical manifestations of TBM in HIV-negative patients. Cyclophosphamide may be safe and effective in treating TBM-associated paradoxical manifestations. Specific diagnostic and care protocols for these patients are needed.
ISSN:1590-1874
1590-3478
DOI:10.1007/s10072-021-05693-2