Abstract
We describe a paradoxical response involving the central nervous system in a patient with steroid-refractory tuberculous meningitis that was unresponsive to systemic corticosteroids but was improved with adalimumab. The immunomodulatory effect of tumor necrosis factor inhibitors may have a role in replacing or enhancing the activity of steroids in the management of steroid-refractory tuberculous meningitis.
MeSH terms
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Adalimumab
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Anti-Inflammatory Agents / therapeutic use*
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Antibodies, Monoclonal, Humanized / therapeutic use*
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Antitubercular Agents / therapeutic use
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Brain / pathology
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Drug Synergism
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Humans
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Male
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Middle Aged
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Steroids / adverse effects
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Steroids / therapeutic use*
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Tuberculosis, Meningeal / drug therapy*
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Tuberculosis, Meningeal / pathology
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Tumor Necrosis Factor-alpha / antagonists & inhibitors
Substances
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Anti-Inflammatory Agents
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Antibodies, Monoclonal, Humanized
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Antitubercular Agents
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Steroids
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Tumor Necrosis Factor-alpha
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Adalimumab