Intractable Tuberculous Meningitis With Paradoxical Reactions Treated by Anti–Tissue Necrosis Factor-α Therapy

Paradoxical reactions during the treatment of tuberculous meningitis indicate the worsening of pre-existing tuberculous lesions or the appearance of new tuberculous lesions in patients who initially showed improvement after anti-tuberculosis treatment.1 High-dose corticosteroid therapy is the most preferred first-line treatment, but there is no definite consensus on the management of paradoxical reactions when corticosteroids have failed. Here, we report successful treatment of a tuberculosis meningitis patient with corticosteroid-refractory paradoxical reaction using anti-tissue necrosis factor α (anti-TNF-α) therapy.