title: Management of paradoxical response in pediatric tubercular meningitis with methylprednisolone.
abstract: Paradoxical response to anti-tubercular drugs remains a diagnostic dilemma. In India where tuberculosis is quite prevalent, paradoxical response to anti-tubercular treatment (ATT) is either misdiagnosed or under-diagnosed. We report two cases of optochiasmatic arachnoiditis due to paradoxical response in children suffering from tuberculous meningitis. Visual acuity was recorded as no light perception in all eyes of both patients while they were taking 4-drug ATT (isoniazid, rifampicin, pyrazinamide and ethambutol). However their systemic conditions did not worsen. They were treated with intravenous methylprednisolone for five days followed by systemic corticosteroids on a tapering dose for four weeks along with ATT. This case report highlights the importance of early recognition of this sight-threatening complication and timely, effective treatment to prevent permanent blindness.
authors.affiliation: Department of Ophthalmology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India.
authors.forename: Nitin
authors.initials: N
authors.lastname: Nema
authors.affiliation: Department of Ophthalmology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India.
authors.forename: Abha
authors.initials: A
authors.lastname: Verma
authors.affiliation: Department of Pediatrics, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India.
authors.forename: Kuldeep
authors.initials: K
authors.lastname: Singh
authors.affiliation: Department of Pediatrics, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India.
authors.forename: Virendra
authors.initials: V
authors.lastname: Mehar
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use*; D001100:Arachnoiditis / Q000175:diagnosis / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D004977:Ethambutol / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D007538:Isoniazid / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D009897:Optic Chiasm / Q000187:drug effects* / Q000473:pathology; D009901:Optic Nerve Diseases / Q000175:diagnosis / Q000188:drug therapy*; D011718:Pyrazinamide / Q000627:therapeutic use; D012293:Rifampin / Q000627:therapeutic use; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000175:diagnosis / Q000188:drug therapy*; D014792:Visual Acuity
chemical_list: D000995:Antitubercular Agents; D005938:Glucocorticoids; D011718:Pyrazinamide; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin; D008775:Methylprednisolone
keywords: Anti-Tubercular Treatment; Intravenous Methylprednisolone; Optochiasmatic Arachnoiditis; Paradoxical Response; Tubercular Meningitis