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Abstract

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Article in Japanese

Case Report

A case of repeated paradoxical reactions in tuberculous meningitis with miliary tuberculosis: Comparisons between the brain MRI and chest CT findings

Yasutaka Hirasawaa,b  Jiro Teradaa  Chiyoko Konob  Yoshihito Yamadab  Yuka Sasakic  Koichiro Tatsumia 

aDepartment of Respirology, Graduate School of Medicine, Chiba University
bDepartment of Respiratory Medicine, JR Tokyo General Hospital
cFukujuji Hospital, Japan Anti-Tuberculosis Association

ABSTRACT

A 53-year-old man who presented with a fever, headache, and a left leg disturbance was admitted to our hospital. A diagnosis of miliary tuberculosis and tuberculous meningitis was made according to the findings of a chest CT scan, brain MRI, cerebrospinal fluid test, and the bacterial culture results of each specimen. Antituberculous therapy (HREZ) was started, and thereafter his symptoms and chest CT images gradually improved. However, on day 33 he had a convulsion. Brain CT and gadolinium-enhanced MRI revealed hydrocephalus and abnormally enhanced areas on the meninges at the base of the brain. He was subsequently diagnosed to have a paradoxical reaction to the tuberculous meningitis because the pulmonary lesions of miliary tuberculosis were successfully improving, and no evidence of any recurrence of tuberculous meningitis was observed. Steroid therapy and ventricular drainage was thus started, and his symptoms thereafter gradually improved. However, on day 75 he experienced a disturbance of consciousness and repeated hydrocephalus. Because brain MRI showed the same abnormal findings as those seen after the first paradoxical reaction, a second paradoxical reaction was thus diagnosed.

KEYWORDS

Tuberculous meningitis  Paradoxical reaction  Miliary tuberculosis 

Received 15 Apr 2016 / Accepted 20 Jun 2016

AJRS, 5(6): 326-330, 2016

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