A teenage girl with altered mental status and paraparesis
© 2024 The Authors..
A teenage girl presented with fever and altered mental status. MRI showed diffuse leptomeningeal enhancement of the brain and spine. She was diagnosed by a positive cerebrospinal fluid (CSF) culture with tuberculous (TB) meningitis and was started on anti-TB medications and corticosteroids. Her mental status improved, but she was noted to have proximal weakness of the lower extremities. In the course of tapering corticosteroids at week 11 of anti-TB therapy, she became acutely confused and febrile. MRI demonstrated interval development of tuberculomas in the brain and a mass lesion in the thoracic spine causing cord compression. Given the clinical picture was suggestive of a paradoxical reaction, the dose of corticosteroids was increased. Infliximab was added when repeat MRI revealed enlargement of the mass lesion in the spine with worsening cord compression. She was successfully tapered off of corticosteroids. Over several months, the patient's motor function recovered fully, and she returned to ambulating without assistance.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:35 |
|---|---|
| Enthalten in: |
Journal of clinical tuberculosis and other mycobacterial diseases - 35(2024) vom: 30. März, Seite 100425 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Miyakawa, Ryo [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Case Reports |
|---|
| Anmerkungen: |
Date Revised 13.03.2024 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
|---|
| doi: |
10.1016/j.jctube.2024.100425 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM36958547X |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM36958547X | ||
| 003 | DE-627 | ||
| 005 | 20240313234855.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240312s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.jctube.2024.100425 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1326.xml |
| 035 | |a (DE-627)NLM36958547X | ||
| 035 | |a (NLM)38468819 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Miyakawa, Ryo |e verfasserin |4 aut | |
| 245 | 1 | 2 | |a A teenage girl with altered mental status and paraparesis |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Revised 13.03.2024 | ||
| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2024 The Authors. | ||
| 520 | |a A teenage girl presented with fever and altered mental status. MRI showed diffuse leptomeningeal enhancement of the brain and spine. She was diagnosed by a positive cerebrospinal fluid (CSF) culture with tuberculous (TB) meningitis and was started on anti-TB medications and corticosteroids. Her mental status improved, but she was noted to have proximal weakness of the lower extremities. In the course of tapering corticosteroids at week 11 of anti-TB therapy, she became acutely confused and febrile. MRI demonstrated interval development of tuberculomas in the brain and a mass lesion in the thoracic spine causing cord compression. Given the clinical picture was suggestive of a paradoxical reaction, the dose of corticosteroids was increased. Infliximab was added when repeat MRI revealed enlargement of the mass lesion in the spine with worsening cord compression. She was successfully tapered off of corticosteroids. Over several months, the patient's motor function recovered fully, and she returned to ambulating without assistance | ||
| 650 | 4 | |a Case Reports | |
| 650 | 4 | |a Host-directed therapy | |
| 650 | 4 | |a Meningitis | |
| 650 | 4 | |a Paradoxical reaction | |
| 650 | 4 | |a Tuberculosis | |
| 650 | 4 | |a Tumor necrosis factor-alpha inhibitor | |
| 700 | 1 | |a Louie, Janice |e verfasserin |4 aut | |
| 700 | 1 | |a Keh, Chris |e verfasserin |4 aut | |
| 700 | 1 | |a Chen, Lisa |e verfasserin |4 aut | |
| 700 | 1 | |a Javid, Babak |e verfasserin |4 aut | |
| 700 | 1 | |a Ernst, Joel D |e verfasserin |4 aut | |
| 700 | 1 | |a Goswami, Neela |e verfasserin |4 aut | |
| 700 | 1 | |a Chow, Felicia C |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Journal of clinical tuberculosis and other mycobacterial diseases |d 2015 |g 35(2024) vom: 30. März, Seite 100425 |w (DE-627)NLM261259628 |x 2405-5794 |7 nnns |
| 773 | 1 | 8 | |g volume:35 |g year:2024 |g day:30 |g month:03 |g pages:100425 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.jctube.2024.100425 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 35 |j 2024 |b 30 |c 03 |h 100425 | ||