1. PROF .DR.J.SANGUMANI M.D.,D.Diab
A TUBERCULAR PARADOX
V MU
PROF .DR.J.SANGUMANI M.D.,D.Diab
DR.R.SUNDARAM M.D.,
DR.K.S.RAGHAVAN M.D.,D.Diab.,

2. 13 yrs old female child presented with new onset seizure – twitching of facial muscles followed by GTCS -3 episodes lasting 10 mins -regaining consciousness after each episode No H/0 fever No H/0 altered sensorium No H/0 head injury No H/0 diarrhea/vomitting

3. No H/0 headache
No H/0 blurring of vision
No H/0 weakness of limbs
No H/o diplopia
No H/0 sensory disturbances
No H/o chronic cough with expectoration
No H/o ear discharge

4. PAST HISTORY
k/c congenital heart block on implanted permanent pacemaker
h/o admission for fever with Multiple cervical Lymph nodes (largest 2*1.5cm) 3 months back
biopsy - granulomatous lymphadenitis
Patient was started on CAT-I Anti tuberculous drugs
Patient on regular CAT-I ATT for past 3 months
Not a k/c diabetes, asthma, thyroid disorder

5. Family history Mother had sputum positive pulmonary TB 6yrs back
She completed ATT

6. GENERAL EXAMINATION Pt conscious Oriented No pallor No icterus
No cyanosis
No clubbing
No pedal edema
Cervical lymphadenopathy multiple tiny nodes <0.5cm

7. vitals Pulse rate – 76/min
regular rhythm ,normal volume, felt in all peripheral vessels, no RRD or RF delay
BP – 110/70mmhg in Right upper limb in supine posture
Spo2 – 98%
RR – 20 /MIN

8. CNS Cranial nerves normal Higher functions normal
No motor or sensory deficit
No cerebellar signs
No neck stiffness
Fundus – no papillodema or choroid tubercles

9. CVS – S1 S2 + no murmur
RS – BAE + no added sounds
Abdomen – soft no organomegaly

10. TREATMENT GIVEN Inj.lorazepam 2mg iv stat
Inj.phenytoin 800mg iv over 30 mins then 100mg iv tds
T.Pyridoxine 100mg 1 od

11. Blood investigations HB, Total count,differential count -normal
RBS, RFT,LFT – NORMAL
CXR – PACEMAKER SEEN ,no other abnormality
Echo – pacemaker lead in position
VVI pacing
EF – 45%
VCTC – not reactive

12. CT BRAIN contrast

13. Report
Well defined ring enhancing lesion in right thalamus,left high parietal region,right caudate,left occipital lobe
Suggestive of multiple tuberculomas

14. DIAGNOSIS
Paradoxical reaction to ATT in form of tuberculoma

15. Treatment Patient was started on Inj.dexamethsone 8mg iv bd - 1 week
Then at discharge T.Prednisolone 5mg 8od -2 weeks
Then gradually tapered
CT brain repeated at 8 th week showed reduction in size of tuberculoma

16. immune reconstitution syndrome
A rare cause of seizure in a patient on ATT