Progression of cns tuberculosis inspite of chemotherapy: a case report

ABSTRACT

A case of tuberculous meningitis with paradoxical progression to multiple brain tuberculoma and drug resistance during treatment has been described. Initially the patient presented as tuberculous meningitis with presence of AFB in CSF. CT scan of brain with controstenhancement revealed no abnormality on admission [5th October 1995]. Patient showed improvement clinically during chemotherapy but subsequently she developed total blindness due to bilateral primary optic atrophy. CT scan [6th November 1995] revealed hydrocephalus with left parietal lobe tuberculoma. V-P shunt was introduced [11th November 1995]. Follow-up CT scan was again done [7th March 1996], as the patient suddenly deteriorated, which detected bilateral multiple tuberculoma in brain. CSF study [21st March 1996] yielded AFB which was resistant to streptomycin and INH. New chemotherapy consisting of rifampicin, INH, pyrazinamide, PAS and ethionamide was continued for one year. Repeat CT scan [18th April 1996] detected regression of previous lesions. Last CSF study was normal. Patient's vision improved significantly though she had optic atrophy