Introduction: The current retrospective analysis focussed on the indications and response of add-on thalidomide in childhood CNS tuberculosis with immune mediated paradoxical reaction. Method: Hospital case records of all children with TBM being followed up under various studies at our institute were screened for documentation of clinicoradiologic PR which was defined as worsening of pre-existing tuberculous lesions or appearance of new lesions in patients whose clinical symptoms have worsened after an initial improvement with anti- tubercular therapy (ATT). Demographic, laboratory and neuroimaging data were entered on an excel sheet and analysed. Results: Forty-five children with TBM were registered during the study period (January 2022 to October 2023). Five (11.1%) patients received thalidomide along with 4-drug ATT and steroids. All five had clinicoradiologic PR with lack of response to a five day course of intravenous pulse methylprednisolone (30mg/kg) followed by six weeks of oral dexamethasone alongwith 4-drug ATT at standard dosage. Clinically 4/5 had hydrocephalus (Increased tuberculomas +- midline shift (3/4), optico-chiasmatic arachnoiditis (1/4)) despite a functioning ventriculoperitoneal shunt; and 1/5 had significantly increased basal exudates with steroid toxicity. Thalidomide was given in incremental doses of 2-8mg/kg for three to seven months. All patients showed clinical and radiological response except one. A child each, developed transient leukopenia and transaminitis. Recurrence of hydrocephalus was noted in one child soon after thalidomide got stopped. Conclusion: A three to six month course of thalidomide at a dose of 4-8mg/kg showed significant clinical and radiologic improvement in steroid refractory paradoxical reaction in children with TBM.

Pawan K Ghanghoriya
All India Institute of Medical Sciences
India

Prashant Jauhari
All India Institute of Medical Sciences
India

Mohana Sundaram
All India Institute of Medical Sciences
India

Atin Kumar
All India Institute of Medical Sciences
India

Sheffali Gulati
All India Institute of Medical Sciences
India