[Paradoxical reactions induced by antituberculous drugs in non-HIV infected patients: a cases series of four patients and literature review]. / Réactions paradoxales sous traitement antituberculeux chez des personnes non infectées par le VIH : quatre nouvelles observations et revue de la littérature.

INTRODUCTION: The features of paradoxical reactions (PR) that occurred in non-HIV infected patients treated with antituberculous drugs are diverse. We report four new cases of such PR and review the literature. PATIENTS AND METHODS: Were included all consecutive patients with PR that occurred in non-HIV infected patients who were treated for tuberculosis and followed-up in the department of internal medicine and infectious diseases between January 1st, 2009 and July 31st, 2010. RESULTS: Three of the patients were male. Their median age was 28.5 years. Tuberculous locations were pulmonary (two instances) and extrapulmonary (three instances). Paradoxical reactions occurred after a median of 5.5 weeks after initiation of antituberculous treatment. The PR presented as hypercalcemia (n=1), spondylitis of the 9th thoracic vertebra (n=1), intracerebral tuberculoma (n=1), pericardial effusion (n=1) and adenitis (n=3). Lymphopenia was present in three patients. Three out of the four patients received corticosteroid. Outcome was favorable in three patients. CONCLUSION: Pardoxical reactions are more common in patients who present with extrapulmonary tuberculosis. Intracerebral tuberculomas and spondylitis may be asymptomatic. Prescription of corticosteroids remains controversial except for intracerebral tuberculoma.

[Intracerebral lesions after TNF-alpha inhibitor therapy with pre-existing sarcoidosis and sacroiliitis]. / Zerebrale Rundherde unter TNF-α-Blocker-Therapie bei vorbestehender Sarkoidose und Sakroiliitis.

This article reports the case of a 55-year-old man who presented with aphasia caused by intracerebral lesions and had a history of pulmonary sarcoidosis. Due to nonsteroidal anti-inflammatory drug-resistant spondyloarthritis TNF-alpha inhibitor treatment was started after a negative tuberculosis screening. Subsequently the patient developed pulmonary tuberculosis and cerebral tuberculoma reactivated by the TNF-alpha inhibitor therapy accompanied by pulmonary sarcoidosis with sacroiliitis and oligoarthritis. This case report emphasises the risk of atypical tuberculosis infections under TNF-alpha inhibitors despite negative results of tuberculosis screening.

Intracranial tuberculoma and hydrocephalus developing during treatment of tuberculous meningitis.

A 3 1/2-year-old boy with tuberculous meningitis is described. He developed hydrocephalus and subsequently an intracranial tuberculoma while receiving appropriate antituberculous therapy. Such a paradoxical response is thought to be due to a hypersensitivity reaction to the infection during antituberculous therapy. Both hydrocephalus and tuberculomata should be looked for if any patient develops new neurological signs or symptoms during treatment of tuberculous meningitis.