Efficacy of Intrathecal Isoniazid and Steroid Therapy in Refractory Tuberculous Meningitis

Nobuyuki Ashizawa; Ryotaro Kubo; Ryuta Tagawa; Yuya Ito; Kazuaki Takeda; Shotaro Ide; Naoki Iwanaga; Ayumi Fujita; Masato Tashiro; Takahiro Takazono; Takeshi Tanaka; Atsushi Nagaoka; Shunsuke Yoshimura; Kenta Ujifuku; Tomohiro Koga; Koji Ishii; Kazuko Yamamoto; Akitsugu Furumoto; Koichi Izumikawa; Katsunori Yanagihara; Hiroshi Mukae

doi:10.2169/internalmedicine.1917-23

CASE REPORTS

Efficacy of Intrathecal Isoniazid and Steroid Therapy in Refractory Tuberculous Meningitis

Nobuyuki Ashizawa, Ryotaro Kubo, Ryuta Tagawa, Yuya Ito, Kazuaki Takeda, Shotaro Ide, Naoki Iwanaga, Ayumi Fujita, Masato Tashiro, Takahiro Takazono, Takeshi Tanaka, Atsushi Nagaoka, Shunsuke Yoshimura, Kenta Ujifuku, Tomohiro Koga, Koji Ishii, Kazuko Yamamoto, Akitsugu Furumoto, Koichi Izumikawa, Katsunori Yanagihara, Hiroshi Mukae

Author information

Nobuyuki Ashizawa
Infection Control and Education Center, Nagasaki University Hospital, Japan
Department of Respiratory Medicine, Nagasaki University Hospital, Japan
Ryotaro Kubo
Department of Respiratory Medicine, Nagasaki University Hospital, Japan
Ryuta Tagawa
Department of Respiratory Medicine, Nagasaki University Hospital, Japan
Department of Respiratory Medicine, Sasebo City General Hospital, Japan
Yuya Ito
Department of Respiratory Medicine, Nagasaki University Hospital, Japan
Kazuaki Takeda
Department of Respiratory Medicine, Nagasaki University Hospital, Japan
Shotaro Ide
Infectious Diseases Experts Training Center, Nagasaki University Hospital, Japan
Naoki Iwanaga
Department of Respiratory Medicine, Nagasaki University Hospital, Japan
Ayumi Fujita
Infection Control and Education Center, Nagasaki University Hospital, Japan
Masato Tashiro
Infection Control and Education Center, Nagasaki University Hospital, Japan
Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Japan
Takahiro Takazono
Department of Respiratory Medicine, Nagasaki University Hospital, Japan
Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Japan
Takeshi Tanaka
Infection Control and Education Center, Nagasaki University Hospital, Japan
Atsushi Nagaoka
Department of Neurology and Strokology, Nagasaki University Hospital, Japan
Shunsuke Yoshimura
Department of Neurology and Strokology, Nagasaki University Hospital, Japan
Kenta Ujifuku
Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
Tomohiro Koga
Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
Koji Ishii
Department of Anesthesiology, Nagasaki University School of Medicine, Japan
Palliative Care Center, Nagasaki University Hospital, Japan
Kazuko Yamamoto
Department of Respiratory Medicine, Nagasaki University Hospital, Japan
Division of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus Graduate School of Medicine, Japan
Akitsugu Furumoto
Infectious Diseases Experts Training Center, Nagasaki University Hospital, Japan
Koichi Izumikawa
Infection Control and Education Center, Nagasaki University Hospital, Japan
Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Japan
Katsunori Yanagihara
Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
Hiroshi Mukae
Department of Respiratory Medicine, Nagasaki University Hospital, Japan

Keywords: tuberculous meningitis, intrathecal injection, neuropsychiatric systemic lupus erythematosus (NPSLE)

JOURNAL OPEN ACCESS

2024 Volume 63 Issue 4 Pages 583-586

DOI https://doi.org/10.2169/internalmedicine.1917-23

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Abstract

Tuberculous meningitis is an infectious disease with high mortality. Literature describing intrathecal therapy for tuberculous meningitis is scarce. We herein report a case of refractory tuberculous meningitis in a 52-year-old woman with underlying neuropsychiatric systemic lupus erythematosus. Despite systemic treatment with anti-tuberculosis drugs and dexamethasone, her meningeal irritation deteriorated. Intrathecal isoniazid and prednisolone administration was therefore initiated, and the symptoms of severe meningeal irritation improved along with head magnetic resonance imaging and cerebrospinal fluid findings. This case report highlights the efficacy of intrathecal isoniazid and steroid injections for refractory tuberculous meningitis, particularly in patients with severe meningeal irritation.

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