Two unusual sequelae of tuberculous meningitis despite treatment.
We describe the case of a 22-year-old HIV-negative male who was diagnosed with tuberculous meningitis and subsequently went on to develop two highly unusual after effects of the meningitis. The first was a tuberculoma, which was discovered 28 days after the meningitis and occurred while the patient was taking a four-drug therapeutic regimen, despite adequate drug susceptibilities. The second was an even more unique sequela: tuberculous radiculomyelitis. This transpired only after the patient's glucocorticoids, which were initiated to treat the tuberculoma, were tapered off. These manifestations were successfully treated with the addition of corticosteroids to the antituberculous regimen. The typical clinical presentations of these diseases are reviewed and various means of pathogenesis proposed.
Blaivas
Allen J
AJ
Division of Pulmonary and Critical Care Medicine and the National Tuberculosis Center, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ 07103, USA. ablaivas@hotmail.com
Lardizabal
Alfred
A
Macdonald
Reynard
R
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009188:Myelitis, Transverse / Q000209:etiology*; D011859:Radiography; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology; D016896:Treatment Outcome; D016862:Tuberculoma, Intracranial / Q000209:etiology*; D014390:Tuberculosis, Meningeal / Q000150:complications* / Q000188:drug therapy
D000305:Adrenal Cortex Hormones