Brainstem tuberculoma as a manifestation of paradoxical reaction in a patient with tuberculous meningitis.

Tuberculosis commonly involves the CNS, During drug treatment of CNS tuberculosis paradoxical response (PR) may occasionally occur. The term “paradoxicalresponse”refers to the development of previously nonexistent tuberculosis lesions or worsening of preexisting lesions during antituberculosis treatment( ATT). Etiology is still not clear but delayed type hypersensitivity and alteration in immune system is thought to be a cause. Continued treatment improves PR without severe sequelae. We report a 41 year-old female patient with tuberculous meningitis(TBM) who developed brainstem tuberculomaduring the course of ATT, after about 9 months of treatment as a paradoxical response to ATT. Early identification, continuation of ATT with steroids and ventriculoperitoneal shunting to relieve raised intracranial pressure resulted in complete recovery of our patient. Clinicians should be aware of this phenomenon as it can lead to clinical worsening as late as 9 months. The objective of this case report is to increase knowledge of clinicians about this phenomenon and also to report its such late occurrence.