title: Milliary tuberculosis with unusual paradoxical response at 3 weeks of antituberculous treatment.
abstract: Milliary Tuberculosis (TB) occurs through lymphohaematogenous dissemination of M. tuberculosis and paradoxical response (PR) is a recognized feature. Respiratory failure, choroid tubercles and brain tuberculomas are some of the complications. Brain tuberculomas mainly occur in the cerebrum, cerebellum, where as involvement of the brainstem is rare. A 31 years old female presented with history of ill health, easy fatigability, excessive sweating and fever of one month duration, dry cough for one week and shortness of breath for 3 days. Provisional diagnosis was disseminated TB complicated by hypoxemic respiratory failure and bilateral choroid tubercles. She was started on anti-TB treatment with adjuvant steroids. The initial response to treatment was remarkable but after about 3 weeks of anti-TB therapy, she suddenly deteriorated developing spastic ataxia. After exclusion of other possible causes she was successfully treated under the impression of having PR.
authors.affiliation: Department of Medicine and Chest Diseases, Dammam Medical Complex (MOH), Dammam, Kingdom of Saudi Arabia. dr_liaqatali@hotmail.com
authors.forename: Liaqat Ali
authors.initials: LA
authors.lastname: Chaudhry
authors.lastname: Ebtesam Ba-Essa
authors.forename: Shehab
authors.initials: S
authors.lastname: Al-Solaiman
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001259:Ataxia / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D001933:Brain Stem; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D013997:Time Factors; D016862:Tuberculoma, Intracranial / Q000175:diagnosis / Q000188:drug therapy*; D014391:Tuberculosis, Miliary / Q000188:drug therapy*
chemical_list: D000995:Antitubercular Agents; D005938:Glucocorticoids