Abstract
A seven and half year old male child presenting with pyrexia of unknown origin was diagnosed to be a case of miliary tuberculosis. Neuroimaging revealed multiple discrete ring as well as nodular enhancing lesions indicative of tuberculomas. After the initial response to ATT along with systemic steroids the child again presented with severe headache along with vomiting towards the end of intensive phase. Repeat neuroimaging showed appearance of new lesions with perilesional edema. Child was started again on systemic steroids and Streptomycin was added to the anti tubercular regimen, to which the child responded well.J Nepal Paediatr Soc 2015;35(2):185-188
Highlights
CNS tuberculosis remains an important cause of mortality and morbidity in developing countries with resurgence in developed countries due to appearance of AIDS
Arachnoidi s and infarcts are other features of neurotuberclosis[2,3]. While these lesions usually resolve following an tubercular therapy (ATT),rarely clinical deteriora on may occur in spite of good ini al recovery. This worsening in neuro-tuberculosis has been a ributed to a paradoxical response and may occur within days and even one year a er star ng standard an tubercular chemotherapy[4,5]
Paradoxical response is defined as recurrence or appearance of fresh symptoms, physical and radiological signs in a pa ent who had previously shown improvement with appropriate anitubercular treatment
Summary
Arachnoidi s and infarcts are other features of neurotuberclosis[2,3] While these lesions usually resolve following an tubercular therapy (ATT),rarely clinical deteriora on may occur in spite of good ini al recovery. This worsening in neuro-tuberculosis has been a ributed to a paradoxical response and may occur within days and even one year a er star ng standard an tubercular chemotherapy[4,5]. Towards the end of intensive phase there was recurrence of severe headache along with vomi ng for 4-5 days His vitals were within normal limits and neurological examina on was normal. MRI repeated at six months revealed complete resolu on except few calcified lesions in cerebellum
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