PARADOXICAL REACTION ON HIV- NEGATIVE SPINAL TUBERCULOUS ARACHNOIDITISPATIENT: A CASE REPORT

Introduction:-Tuberculosis is a major public health issue in our country. Central nervous system tuberculosis has severe life threatening sequalae. The diagnosis of this form of tuberculosis is still challenging. Thus, availability of data about symptoms, paths of treatment, and eventual outcomes could be beneficial for practicians. Hence, we are reporting a case of paradoxical response on patient with tuberculous meningitis (TBM) complicated with spinal arachnoiditis.

Case Presentation:-We report a case of a 26 yearsold HIV- negative man, admitted on juanuary the 28 th withheadeche, fever syndrome, ptosis, behavioral, neurological and sphincter disorders. Medullary Magnetic Resonance Imaging (MRI) showed extensive cervical-dorsal-lumbar epiduritis with nodular epiduritis posterior to L1, besides a radiculitis extended cauda equina syndrome and cervical-medullary cystic dilatation at D2 and L1 suggestive as arachnoiditis. Treatment was lunched with regimen including four main drugs: isoniazid, rifampin, pyrazinamide, and ethambutol. After two months, the patient showed a paradoxical reaction. Adjuvant treatment was given to consolidate first line treatment. The patient state got improved and was discharged with a scheduled follow-up visit.

Conclusion:-During the treatment of TBM, a paradoxical reaction can occur at any time. Quick diagnosis, appropriate treatment, and constant reevaluation of care protocols may reduce the likelihood of complications and sequalae