Infliximab for Paradoxical Reactions in Pediatric Central Nervous System Tuberculosis

Yara-Natalie Abo; Nigel Curtis; Joshua Osowicki; Gabrielle Haeusler; Rachael Purcell; Seilesh Kadambari; Matthias De Wachter; Koen Vanden Driessche; Sven Dekeyzer; Lee Coleman; Nigel Crawford; Steve Graham; Ben Marais; Amanda Gwee

doi:10.1093/jpids/piab094

Infliximab for Paradoxical Reactions in Pediatric Central Nervous System Tuberculosis

J Pediatric Infect Dis Soc. 2021 Dec 31;10(12):1087-1091. doi: 10.1093/jpids/piab094.

Authors

Yara-Natalie Abo¹, Nigel Curtis^{1

2

3}, Joshua Osowicki^{1

2

3}, Gabrielle Haeusler^{1

2

4}, Rachael Purcell¹, Seilesh Kadambari¹, Matthias De Wachter⁵, Koen Vanden Driessche^{6

7

8}, Sven Dekeyzer⁹, Lee Coleman¹⁰, Nigel Crawford¹¹, Steve Graham^{2

3}, Ben Marais^{12

13}, Amanda Gwee^{1

2

3}

Affiliations

¹ Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.
² Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.
³ Murdoch Children's Research Institute, Parkville, Victoria, Australia.
⁴ Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
⁵ Division of Paediatric Neurology, Department of Paediatrics, Antwerp University Hospital, University of Antwerp, Edegem, Belgium.
⁶ Division of Paediatric Pulmonology, Department of Paediatrics, University Hospital Antwerp, Edegem, Belgium.
⁷ Section of Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands.
⁸ DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research and SA/MRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
⁹ Department of Radiology, Antwerp University Hospital (UZA), Edegem, Belgium.
¹⁰ Department of Radiology, Royal Children's Hospital, Melbourne, Victoria, Australia.
¹¹ Department of Paediatrics, Royal Children's Hospital, Melbourne, Victoria, Australia.
¹² The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
¹³ Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.

PMID: 34608937
DOI: 10.1093/jpids/piab094

Abstract

Paradoxical reactions in central nervous system tuberculosis (CNS-TB) are associated with significant morbidity and mortality. We describe 4 HIV-uninfected children treated for CNS-TB with severe paradoxical reactions unresponsive to corticosteroids. All made recovery after treatment with infliximab, highlighting the safety and effectiveness of infliximab for this complication, and need for prospective trials.

Keywords: central nervous system tuberculosis; infliximab; paradoxical reaction; tuberculous meningitis.

© The Author(s) 2021. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

MeSH terms

Adrenal Cortex Hormones
Antitubercular Agents* / adverse effects
Child
Humans
Infliximab / adverse effects
Prospective Studies
Tuberculosis, Central Nervous System* / drug therapy

Substances

Adrenal Cortex Hormones
Antitubercular Agents
Infliximab