Paradoxical reaction in HIV-negative tuberculous meningitis patients with spinal involvement

Abstract

Objective: The aim of this study was to investigate the occurrence of paradoxical reaction (PR) in HIV-negative tuberculous meningitis (TBM) patients with spinal involvement, as well as its possible risk factors.

Methods: Fifty TBM patients with spinal involvement were studied retrospectively and divided into a PR group and a non-PR group according to the presence of PR. Their demographic, clinical, radiological, and laboratory data, and status at follow-up were collected and compared.

Results: PR developed in 26 patients (52%), with the median time to the development of PR being 30days (range 15-330 days) after the initiation of tuberculosis therapy. At initial diagnosis, age, documented acid-fast bacilli (AFB), and the cerebrospinal fluid protein level were found to differ significantly between the two groups. After multivariate analysis, age, documented AFB, and vertebral involvement were significantly associated with the development of PR.

Conclusions: PR was common in TBM patients with spinal involvement. Age, documented AFB, and musculoskeletal involvement may be predictors of PR development.

Keywords: Cerebrospinal fluid; Paradoxical reaction; Spinal; Tuberculous meningitis.