Universität zu Köln

Suarez, Isabelle, Gruell, Henning, Heyckendorf, Jan, Fuenger, Sarah, Lichtenstein, Thorsten, Jung, Norma, Lehmann, Clara, Unnewehr, Markus, Faetkenheuer, Gerd, Lange, Christoph and Rybniker, Jan (2020). Intensified adjunctive corticosteroid therapy for CNS tuberculomas. Infection, 48 (2). S. 289 - 294. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1439-0973

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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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Suarez, Isabelle UNSPECIFIED UNSPECIFIED UNSPECIFIED Gruell, Henning UNSPECIFIED UNSPECIFIED UNSPECIFIED Heyckendorf, Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED Fuenger, Sarah UNSPECIFIED UNSPECIFIED UNSPECIFIED Lichtenstein, Thorsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Jung, Norma UNSPECIFIED UNSPECIFIED UNSPECIFIED Lehmann, Clara UNSPECIFIED UNSPECIFIED UNSPECIFIED Unnewehr, Markus UNSPECIFIED UNSPECIFIED UNSPECIFIED Faetkenheuer, Gerd UNSPECIFIED UNSPECIFIED UNSPECIFIED Lange, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Rybniker, Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-339594
DOI:	10.1007/s15010-019-01378-3
Journal or Publication Title:	Infection
Volume:	48
Number:	2
Page Range:	S. 289 - 294
Date:	2020
Publisher:	SPRINGER HEIDELBERG
Place of Publication:	HEIDELBERG
ISSN:	1439-0973
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language INTRACRANIAL TUBERCULOMAS; MENINGITIS Multiple languages Infectious Diseases Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/33959