Santín Cerezales, MiguelEscrich, CristinaMajós Torró, CarlosLlaberia, MarionaGrijota Camino, Mª de los DesamparadosGrau, Imma2021-06-082021-06-082020-10-230025-7974https://hdl.handle.net/2445/178095Rationale: 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.7 p.application/pdfengcc-by (c) Santín Cerezales, Miguel et al., 2020https://creativecommons.org/licenses/by/4.0/TuberculosiInflamacióTuberculosisInflammationinfo:eu-repo/semantics/article7054222021-06-08info:eu-repo/semantics/openAccess