Potential disease trigger as a therapeutic option: infliximab for paradoxical reaction in tuberculosis of the central nervous system

A 36-year-old man of central Asian origin was diagnosed with subacute disseminated tuberculosis. Initially, central nervous system involvement was suggested by an encephalopathic condition and MRI showing extensive basal and spinal meningitis. After initiation of anti-tuberculosis drugs and corticos...

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Bibliographic Details
Published in:BMJ case reports 2021-08, Vol.14 (8), p.e235511
Main Authors: Briner, Myriam, Oberholzer, Michael, Wagner, Franca, Chan, Andrew
Format: Article
Language:English
Subjects:
Adrenal Cortex Hormones - therapeutic use
Adult
Antitubercular Agents - therapeutic use
Ataxia
Case Report
Case reports
Central Nervous System
Drug dosages
Fecal incontinence
Fever
Gait
Glucose
Headaches
HIV
Human immunodeficiency virus
Humans
Immune Reconstitution Inflammatory Syndrome - drug therapy
Infliximab - adverse effects
Meningitis
Monoclonal antibodies
Nervous system
Neurological disorders
Patients
Proteins
Spinal cord
Stroke
TNF inhibitors
Tuberculosis
Tuberculosis, Miliary - drug therapy
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Summary:A 36-year-old man of central Asian origin was diagnosed with subacute disseminated tuberculosis. Initially, central nervous system involvement was suggested by an encephalopathic condition and MRI showing extensive basal and spinal meningitis. After initiation of anti-tuberculosis drugs and corticosteroid therapy, clinical and radiological deterioration of spinal damage was noted. We interpreted this in the context of a paradoxical reaction, which is suggested to be an overshooting inflammatory response after reconstitution of the immune system. Despite increased dosage of corticosteroids, a gradual worsening of gait ataxia over several weeks was noted. After administration of infliximab, the patient’s condition progressively improved.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2020-235511