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Title: | Tumor necrosis factor antagonists for paradoxical inflammatory reactions in the central nervous system tuberculosis: Case report and review |
Author: | Santín Cerezales, Miguel Escrich, Cristina Majòs, Carles Llaberia, Mariona Grijota, María D. Grau, Imma |
Keywords: | Tuberculosi Inflamació Tuberculosis Inflammation |
Issue Date: | 23-Oct-2020 |
Publisher: | Lippincott, Williams & Wilkins. Wolters Kluwer Health |
Abstract: | Rationale: Paradoxical reaction/immune reconstitution inflammatory syndrome is common in patients with central nervous system tuberculosis. Management relies on high-dose corticosteroids and surgery when feasible. Patient concern: We describe 2 cases of HIV-negative patients with corticosteroid-refractory paradoxical reactions of central nervous system tuberculosis. Diagnoses: The 2 patients experienced clinical impairment shortly after starting therapy for TB, and magnetic resonance imaging showed the presence of tuberculomas, leading to the diagnosis of a paradoxical reaction. Interventions: We added infliximab, an anti-tumor necrosis factor (TNF)-alpha monoclonal antibody, to the dexamethasone. Outcomes: Both patients had favorable outcomes, 1 achieving full recovery but 1 suffering neurologic sequelae. Lessons: Clinicians should be aware of the risk of paradoxical reactions/immune reconstitution inflammatory syndrome when treating patients with tuberculosis of the central nervous system and should consider the prompt anti-TNF-α agents in cases not responding to corticosteroids. |
Note: | Reproducció del document publicat a: https://doi.org/10.1097/MD.0000000000022626 |
It is part of: | Medicine, 2020, vol. 99, num. 43, p. e22626 |
URI: | http://hdl.handle.net/2445/178095 |
Related resource: | https://doi.org/10.1097/MD.0000000000022626 |
ISSN: | 0025-7974 |
Appears in Collections: | Articles publicats en revistes (Ciències Clíniques) Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL)) |
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