Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Paradoxical Deterioration of Intramedullary Spinal Tuberculomas during Antituberculous Therapy

  • Jang, Keum-Jun (Department of Neurosurgery, National Medical Center) ;
  • Jwa, Cheol-Su (Department of Neurosurgery, National Medical Center) ;
  • Kim, Kang-Hyun (Department of Neurosurgery, National Medical Center) ;
  • Kang, Jae-Kyu (Department of Neurosurgery, National Medical Center)
  • Published : 2007.06.30
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Abstract

"Paradoxical deterioration" during antituberculous therapy is generally defined as the clinical or radiological worsening of pre-existing tuberculous lesions or the development of new lesions in a patient who initially improves. The phenomenon of paradoxical deterioration in intramedullary tuberculoma of the spinal cord is rare and is a less established entity. The authors present an unusual case of paraparesis as a result of paradoxical deterioration of intramedullary tuberculoma despite adequate antituberculous therapy. Here, we review the relevant literatures and discuss its possible pathogenic mechanisms.

Keywords

References

  1. Campbell IA, Dyson AJ : Lymph node tuberculosis : a comparison of various methods of treatment. Tubercle 58 : 171-179, 1977 https://doi.org/10.1016/0041-3879(77)90041-1
  2. Chambers ST, Hendrickse WA, Record C, Rudge P, Smith H : Paradoxical expansion of intracranial tuberculomas during chemotherapy. Lancet 28 : 181-184, 1984
  3. Cheng VC, Ho PL, Lee RA, Chan KS, Chan KK, Woo PC, et al : Clinical spectrum of paradoxical deterioration during antituberculosis therapy in non-HIV-infected patients. Eur J Clin Microbiol Infect Dis 21 : 803-809, 2002 https://doi.org/10.1007/s10096-002-0821-2
  4. Chien JW, Johnson JL : Paradoxical reactions in HIV and pulmonary TB. Chest 114 : 933-936, 1998 https://doi.org/10.1378/chest.114.3.933
  5. Citow JS, Ammirati M : Intramedullary tuberculoma of the spinal cord : case report. Neurosurgery 35 : 327-330, 1994 https://doi.org/10.1227/00006123-199408000-00024
  6. Joseph P, Severe P, Ferdinand S, Goh KS, Sola C, Haas DW, et al : Multidrug-resistant tuberculosis at an HIV testing center in Haiti. AIDS 20 : 415-418, 2006 https://doi.org/10.1097/01.aids.0000206505.09159.9a
  7. Kumar R, Prakash M, Jha S : Paradoxical response to chemotherapy in neurotuberculosis. Pediatr Neurosurg 42 : 214-222, 2006 https://doi.org/10.1159/000092357
  8. Lin SK, Wu T, Wai YY : Intramedullary spinal tuberculomas during treatment of tuberculous meningitis. Clin Neurol Neurosurg 96 : 71-78, 1994 https://doi.org/10.1016/0303-8467(94)90033-7
  9. Pablos-Mendez A, Raviglione MC, Laszlo A, Binkin N, Rieder HL, Bustreo F, et al : Global surveillance for antituberculosis-drug resistance, 1994-1997. World Health Organization-International Union against Tuberculosis and Lung Disease Working Group on Anti-Tuberculosis Drug Resistance Surveillance. N Engl J Med 338 : 1641-1649, 1998 https://doi.org/10.1056/NEJM199806043382301
  10. Rao GP, Nadh BR, Hemaratnan A, Srinivas TV, Reddy PK : Paradoxical progression of tuberculous lesions during chemotherapy of central nervous system tuberculosis. Report of four cases. J Neurosurg 83 : 359-362, 1995 https://doi.org/10.3171/jns.1995.83.2.0359
  11. Schoeman JF, Fieggen G, Seller N, Mendelson M, Hartzenberg B : Intractable intracranial tuberculous infection responsive to thalidomide : report of four cases. J Child Neurol 21 : 301-308, 2006 https://doi.org/10.1177/08830738060210040801
  12. Schoeman JF, Springer P, van Rensburg AJ, Swanevelder S, Hanekom WA, Haslett PA, et al : Adjunctive thalidomide therapy for childhood tuberculous meningitis : results of a randomized study. J Child Neurol 19 : 250-257, 2004 https://doi.org/10.1177/088307380401900402
  13. Skendros P, Kamaria F, Kontopoulos V, Tsitouridis I, Sidiropoulos L : Intradural, extramedullary tuberculoma of the spinal cord as a complication of tuberculous meningitis. Infection 31 : 115-117, 2003 https://doi.org/10.1007/s15010-002-3019-8
  14. Teoh R, Humphries MJ, O'Mahony G : Symptomatic intracranial tuberculoma developing during treatment of tuberculosis: a report of 10 patients and review of the literature. Q J Med 63 : 449-460, 1987
  15. Thrush DC, Barwick DD : Three patients with intracranial tuberculomas with unusual features. J Neurol Neurosurg Psychiatry 37 : 566-569, 1974 https://doi.org/10.1136/jnnp.37.5.566