Abstract
We present two cases of tuberculous meningitis (TBM) in adults complicated by focal
neurological deficits which showed progression whilst on steroids. In case 1 an MRI
demonstrated multiple ring-enhancing lesions compressing the optic chiasm leading
to a bitemporal hemianopia. After the introduction of thalidomide serial imaging and
field perimetry at 6, 9, 12 and 24 months into treatment showed progressive improvement.
In case 2, two months into anti-tuberculous treatment with steroids, the patient developed
fluctuating right sided paralysis with the MRI demonstrating a large ring-enhancing
mass encasing the left internal carotid and middle cerebral arteries. Thalidomide
was introduced as an immunomodulatory adjunct and subsequently the patient made a
complete neurological recovery. The immunomodulatory effects of thalidomide may have
a role in the acute and chronic management of TBM complicated by intracranial tuberculomas.
Keywords
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References
- Streptomycin in tuberculosis trials committee. Streptomycin treatment of tuberculous meningitis.Lancet. 1948; 1: 582-597
- A critical evaluation of corticosteroids in tuberculosis.Bibl Tuberc. 1966; 22: 1-54
- Steroids for treating tuberculous meningitis.Cochrane Database Syst Rev. 2000; 3 (CD002244)
- Paradoxical enlargement or development of intracranial tuberculomas during therapy: case report and review.Clin Infect Dis. 1994; 19: 1092-1099
- Repeated deterioration of tuberculous meningitis due to a reduction in the corticosteroid dosage during chemotherapy.Rinsho Shinkeigaku. 2000; 40: 1018-1022
Sampaio EP, Kaplan G, Miranda A, et al. The influence of thalidomide on the clinical and immunological manifestation of erythema nodosum leprosum. J Infect Dis 1993;168:408–414.
- Tumour necrosis factor alpha is a determinant of pathogenesis and disease progression in mycobacterial infection in the central nervous system.Proc Natl Acad Sci USA. 1999; 96: 5657-5662
- Thalidomide reduces tumour necrosis factor alpha production by human alveolar macrophages.Resp Med. 1997; 91: 31-39
- Effect of cytokine modulation by thalidomide on the granulomatous response in murine tuberculosis.Tuber Lung Dis. 1997; 78: 47-55
- A combination of thalidomide plus antibiotics protects rabbits from Mycobacterial meningitis-associated death.J Infect Dis. 1998; 177: 1563-1572
- Adjuctive thalidomide therapy of childhood tuberculous meningitis: possible anti-inflammatory role.J Child Neurol. 2000; 15: 497-503
- Thalidomide therapy in childhood meningitis.J Child Neurol. 2000; 15: 838
- Clinical and immunological benefit of adjuvant therapy with thalidomide in the treatment of tuberculous disease.AIDS. 2000; 14: 1859-1861
- Thalidomide costimulates primary human T lymphocytes preferentially inducing proliferation, cytokine production and cytokine responses in the CD8+ subset.J Exp Med. 1998; 187: 1885-1892
- Thalidomide and its analogues have distinct and opposing effects on TNF-alpha and TNFR2 during co-stimulation of both CD4(+) and CD8(+) T cells.Clin Exp Immunol. 2002; 130: 75-84
- Use of ImiD3, a thalidomide analog, as an adjunct to therapy for experimental tuberculous meningitis.Antimicrob Agents Chemother. 2002; 46: 1887-1895
Article info
Publication history
Accepted:
May 11,
2003
Identification
Copyright
© 2003 The British Infection Society. Published by Elsevier Inc. All rights reserved.
