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.
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Acknowledgements
We thank Paul Higgins (PhD) at the Institute for Medical Microbiological, Immunology and Hygiene (Cologne) for critical reading of the manuscript.
Funding
J. R. receives funding from the Thematic Translational Unit Tuberculosis (TTU TB, Grant number TTU 02.806 and 02.905) of the German Center of Infection Research (DZIF). Financial support was also received from the German Research Foundation (DFG RY 159) and the Center for Molecular Medicine Cologne (ZMMK-CAP8). I. S. receives funding by the German Center for Infection Research (DZIF) (Grant number TTU 02.806 and 02.905, Grant number TI 07.001_SUAREZ_00).
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JR, HG, SF, GF, and IS developed the first draft outline, wrote parts of the manuscript, and coordinated patient treatment; Subsequent drafts were developed by CL, NJ, TL, JH, CL, and MU. All authors were involved in patient care. All authors contributed to all sections relevant to their experience and helped finalize the text and content.
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The authors declare no competing financial interest.
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Suárez, I., Gruell, H., Heyckendorf, J. et al. Intensified adjunctive corticosteroid therapy for CNS tuberculomas. Infection 48, 289–293 (2020). https://doi.org/10.1007/s15010-019-01378-3
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DOI: https://doi.org/10.1007/s15010-019-01378-3