Recovery of vision after adjuvant thalidomide in a child with tuberculous meningitis and acute lymphoblastic leukemia.
A 7-year-old child, on maintenance chemotherapy for acute lymphoblastic leukemia, developed tuberculous meningitis complicated by progressive basal meningeal inflammation and abscess formation, in spite of adequate tuberculosis treatment and adjunctive corticosteriod therapy. The child became blind as a result of involvement of the optic chiasm. After 2 months of adjunctive thalidomide therapy, the child regained vision and cranial magnetic resonance imaging showed marked reduction of the inflammatory changes previously demonstrated. Progression of intracranial tuberculous infection, in spite of a treatment that is generally considered to be adequate, is well recognized. Previous reports of a possible beneficiary role of thalidomide in these cases support an immunological basis. The present case suggests a role for thalidomide in the treatment of blindness due to involvement of the optic chiasm in progressive basal tuberculous meningitis.
Stefan
Daniela Cristina
DC
Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, Tygerberg Children's Hospital, Cape Town, South Africa. cs@sun.ac.za
Andronikou
Savvas
S
Freeman
Nicola
N
Schoeman
Johan
J
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001766:Blindness / Q000188:drug therapy* / Q000209:etiology; D001921:Brain / Q000187:drug effects / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D002648:Child; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D009897:Optic Chiasm / Q000187:drug effects / Q000503:physiopathology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D020127:Recovery of Function / Q000187:drug effects; D013792:Thalidomide / Q000627:therapeutic use*; D014390:Tuberculosis, Meningeal / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D014785:Vision, Ocular / Q000187:drug effects*
D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D013792:Thalidomide