Isabelle Suárez1,2, Henning Gruell2,3, Jan Heyckendorf4,5,6, Sarah Fünger1, Thorsten Lichtenstein7, Norma Jung1, Clara Lehmann1,2,8, Markus Unnewehr9,10, Gerd Fätkenheuer1,2, Christoph Lange4,5,11,6, Jan Rybniker12,13,14. 1. Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany. 2. German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany. 3. Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931, Cologne, Germany. 4. Research Center Borstel, Clinical Infectious Diseases, Borstel, Germany. 5. Partner site Hamburg-Lübeck-Borstel, German Center for Infection Research (DZIF), Borstel, Germany. 6. International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany. 7. Faculty of Medicine and University Hospital of Cologne, Institute of Diagnostic and Interventional Radiology, University of Cologne, Cologne, Germany. 8. Center for Molecular Medicine Cologne, University of Cologne, 50931, Cologne, Germany. 9. Department of Respiratory Medicine and Infectious Diseases, St. Barbara-Klinik, Hamm, Germany. 10. University of Witten-Herdecke, Witten, Germany. 11. Department of Internal Medicine, Karolinska Institute, Stockholm, Sweden. 12. Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany. jan.rybniker@uk-koeln.de. 13. German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany. jan.rybniker@uk-koeln.de. 14. Center for Molecular Medicine Cologne, University of Cologne, 50931, Cologne, Germany. jan.rybniker@uk-koeln.de.
Abstract
INTRODUCTION: Central nervous system (CNS) tuberculomas are a challenging manifestation of extrapulmonary tuberculosis often leading to neurological complications and post-treatment sequelae. The role of adjunctive corticosteroid treatment is not fully understood. Most guidelines on management of tuberculosis do not distinguish between tuberculous meningitis and CNS tuberculomas in terms of corticosteroid therapy. METHODS: We describe five patients with CNS tuberculomas who required intensified dexamethasone treatment for several months, in two cases up to 18 months. RESULTS: These patients were initially treated with the standard four-drug tuberculosis regimen and adjuvant dexamethasone. Neurological symptoms improved rapidly. However, multiple attempts to reduce or discontinue corticosteroids according to guideline recommendations led to clinical deterioration with generalized seizures or new CNS lesions. Thus, duration of adjunctive corticosteroid therapy was extended eventually leading to clinical cure and resolution of lesions. CONCLUSION: In contrast to tuberculous meningitis, the treatment for CNS tuberculomas appears to require a prolonged administration of corticosteroids. These findings need to be verified in controlled clinical studies.
INTRODUCTION: Central nervous system (CNS) tuberculomas are a challenging manifestation of extrapulmonary tuberculosis often leading to neurological complications and post-treatment sequelae. The role of adjunctive corticosteroid treatment is not fully understood. Most guidelines on management of tuberculosis do not distinguish between tuberculous meningitis and CNS tuberculomas in terms of corticosteroid therapy. METHODS: We describe five patients with CNS tuberculomas who required intensified dexamethasone treatment for several months, in two cases up to 18 months. RESULTS: These patients were initially treated with the standard four-drug tuberculosis regimen and adjuvant dexamethasone. Neurological symptoms improved rapidly. However, multiple attempts to reduce or discontinue corticosteroids according to guideline recommendations led to clinical deterioration with generalized seizures or new CNS lesions. Thus, duration of adjunctive corticosteroid therapy was extended eventually leading to clinical cure and resolution of lesions. CONCLUSION: In contrast to tuberculous meningitis, the treatment for CNS tuberculomas appears to require a prolonged administration of corticosteroids. These findings need to be verified in controlled clinical studies.
Authors: Bryce K Chang; Jacqueline Adlawan; Samuel Fesenmeier; David Kaminskas; Enrique Carrazana; Kore K Liow Journal: Hawaii J Health Soc Welf Date: 2022-06