Tratamiento de meningitis tuberculosa en paciente HIV negativo, posible reacción paradojal

摘要

Possible paradoxical reaction to treatment of tuberculous meningitis in an HIV negative patientThe paradoxical response to tuberculosis treatment consists in the appearance of new clinical or radiologic manifestations or worsening of previousinjuries after an initial improvement with anti-tuberculosis therapy. It can be observed in 6 to 30 percent of the cases of tubercular meningitis. It is theconsequence of an exaggerated immune reaction that should be considered since the treatment is based on the use of immunomodulators and not inthe change of anti-tuberculous drugs. We present the case of an HIV negative adult with tuberculous meningitis with a good initial response to specifictherapy who showed, 10 weeks later, a paradoxical reaction to treatment that responded successfully to corticosteroids.