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Middle East African Journal of Ophthalmology Middle East African Journal of Ophthalmology
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Year : 2014  |  Volume : 21  |  Issue : 2  |  Page : 189-192

Management of paradoxical response in pediatric tubercular meningitis with methylprednisolone

1 Department of Ophthalmology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
2 Department of Pediatrics, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India

Correspondence Address:
Nitin Nema
Department of Ophthalmology, SAIMS, 55 Shri Nagar Main, Indore - 452 018, Madhya Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0974-9233.129775

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Paradoxical response to anti-tubercular drugs remains a diagnostic dilemma. In India where tuberculosis is quite prevalent, paradoxical response to anti-tubercular treatment (ATT) is either misdiagnosed or under-diagnosed. We report two cases of optochiasmatic arachnoiditis due to paradoxical response in children suffering from tuberculous meningitis. Visual acuity was recorded as no light perception in all eyes of both patients while they were taking 4-drug ATT (isoniazid, rifampicin, pyrazinamide and ethambutol). However their systemic conditions did not worsen. They were treated with intravenous methylprednisolone for five days followed by systemic corticosteroids on a tapering dose for four weeks along with ATT. This case report highlights the importance of early recognition of this sight-threatening complication and timely, effective treatment to prevent permanent blindness.

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