title: Paradoxical reaction in HIV negative tuberculous meningitis.
abstract: This review focusses on paradoxical reactions occurring during the treatment of tuberculous meningitis (TBM) in human immunodeficiency virus-negative cases. A paradoxical reaction is defined as the worsening of a pre-existing lesion or the appearance of new lesion in a patient whose clinical symptoms initially improved with anti-tuberculosis treatment. A number of different paradoxical reactions have been reported in patients with TBM including expansion of existing cerebral tuberculomas, and appearance of new tuberculomas, hydrocephalus, and optochiasmatic and spinal arachnoiditis. While the exact mechanism of paradoxical reactions is uncertain, an exaggerated immune reaction against Mycobacterium tuberculosis-associated antigens is currently the most accepted theory for tuberculous paradoxical reaction. Corticosteroids are considered to have a beneficial effect in the management of paradoxical reactions. Immuno-modulatory drugs, including tumor necrosis factor-α antagonists, thalidomide and interferon-γ have been used in isolated cases with more severe forms of paradoxical reactions.
authors.affiliation: Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India. Electronic address: garg50@yahoo.com.
authors.forename: Ravindra Kumar
authors.initials: RK
authors.lastname: Garg
authors.affiliation: Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Hardeep Singh
authors.initials: HS
authors.lastname: Malhotra
authors.affiliation: Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Kumar
mesh_terms: D000995:Antitubercular Agents / Q000009:adverse effects*; D001927:Brain Diseases / Q000139:chemically induced / Q000209:etiology / Q000473:pathology; D002490:Central Nervous System / Q000187:drug effects / Q000382:microbiology / Q000473:pathology; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000472:pathogenicity; D014390:Tuberculosis, Meningeal / Q000188:drug therapy* / Q000503:physiopathology*
chemical_list: D000995:Antitubercular Agents
keywords: Central nervous system; Corticosteroids; Hydrocephalus; Mycobacterium tuberculosis; Tuberculoma; Tuberculosis