Asunto(s)
Adalimumab/efectos adversos , Antiinflamatorios/efectos adversos , Artritis Psoriásica/tratamiento farmacológico , Infecciones Oportunistas/inducido químicamente , Tuberculoma Intracraneal/inducido químicamente , Tuberculosis Pulmonar/inducido químicamente , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Cerebro , Humanos , Masculino , Persona de Mediana Edad , Infecciones Oportunistas/complicaciones , Tuberculoma Intracraneal/complicaciones , Tuberculosis Pulmonar/complicacionesRESUMEN
INTRODUCTION: The features of paradoxical reactions (PR) that occurred in non-HIV infected patients treated with antituberculous drugs are diverse. We report four new cases of such PR and review the literature. PATIENTS AND METHODS: Were included all consecutive patients with PR that occurred in non-HIV infected patients who were treated for tuberculosis and followed-up in the department of internal medicine and infectious diseases between January 1st, 2009 and July 31st, 2010. RESULTS: Three of the patients were male. Their median age was 28.5 years. Tuberculous locations were pulmonary (two instances) and extrapulmonary (three instances). Paradoxical reactions occurred after a median of 5.5 weeks after initiation of antituberculous treatment. The PR presented as hypercalcemia (n=1), spondylitis of the 9th thoracic vertebra (n=1), intracerebral tuberculoma (n=1), pericardial effusion (n=1) and adenitis (n=3). Lymphopenia was present in three patients. Three out of the four patients received corticosteroid. Outcome was favorable in three patients. CONCLUSION: Pardoxical reactions are more common in patients who present with extrapulmonary tuberculosis. Intracerebral tuberculomas and spondylitis may be asymptomatic. Prescription of corticosteroids remains controversial except for intracerebral tuberculoma.
Asunto(s)
Antituberculosos/efectos adversos , Adulto , Femenino , Glucocorticoides/uso terapéutico , Humanos , Hipercalcemia/inducido químicamente , Linfadenitis/inducido químicamente , Linfopenia/inducido químicamente , Masculino , Derrame Pericárdico/inducido químicamente , Estudios Retrospectivos , Espondilitis/inducido químicamente , Vértebras Torácicas , Tuberculoma Intracraneal/inducido químicamenteRESUMEN
This article reports the case of a 55-year-old man who presented with aphasia caused by intracerebral lesions and had a history of pulmonary sarcoidosis. Due to nonsteroidal anti-inflammatory drug-resistant spondyloarthritis TNF-alpha inhibitor treatment was started after a negative tuberculosis screening. Subsequently the patient developed pulmonary tuberculosis and cerebral tuberculoma reactivated by the TNF-alpha inhibitor therapy accompanied by pulmonary sarcoidosis with sacroiliitis and oligoarthritis. This case report emphasises the risk of atypical tuberculosis infections under TNF-alpha inhibitors despite negative results of tuberculosis screening.
Asunto(s)
Antiinflamatorios/efectos adversos , Sacroileítis/complicaciones , Sarcoidosis/complicaciones , Tuberculoma Intracraneal/inducido químicamente , Tuberculoma Intracraneal/diagnóstico , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Antiinflamatorios/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Sacroileítis/tratamiento farmacológico , Sarcoidosis/tratamiento farmacológico , Resultado del TratamientoAsunto(s)
Anticuerpos Monoclonales/efectos adversos , Enfermedad de Crohn/tratamiento farmacológico , Tuberculoma Intracraneal/inducido químicamente , Tuberculoma Intracraneal/diagnóstico , Antituberculosos/uso terapéutico , Enfermedad de Crohn/diagnóstico , Humanos , Infliximab , Masculino , Persona de Mediana Edad , Tuberculoma Intracraneal/tratamiento farmacológicoRESUMEN
A 3 1/2-year-old boy with tuberculous meningitis is described. He developed hydrocephalus and subsequently an intracranial tuberculoma while receiving appropriate antituberculous therapy. Such a paradoxical response is thought to be due to a hypersensitivity reaction to the infection during antituberculous therapy. Both hydrocephalus and tuberculomata should be looked for if any patient develops new neurological signs or symptoms during treatment of tuberculous meningitis.