Abstract:

Objective: To analyze the clinical effectiveness and safety of low dose thalidomide in the adjuvant treatment of tuberculous meningitis (TBM) complicated with paradoxical reactions in adults. Methods: A total of 20 patients who met the diagnostic criteria of TBM complicated with paradoxical reactions admitted to Changchun Infectious Disease Hospital from January 1, 2020 to December 30, 2022 were selected for retrospective study. Oral thalidomide (25 mg, 4 times/day) was administered without adjusting the dosage of original hormone and anti-tuberculosis therapy regimen. Clinical symptoms, cerebrospinal fluid (CSF) parameters, imaging findings and adverse drug reactions were analyzed. Results: Among the 20 patients, 14 (70.0%) had new tuberculoma, 11 (55.0%) had deterioration of original tuberculoma, 10 (50.0%) had increased cisternal effusion, and 5 (25.0%) had new cerebral infarction. After treatment with thalidomide, the lesions of 14 patients with new tuberculoma and 11 patients with deterioration of original tuberculoma improved significantly, tuberculous nodules ≤3 mm could be completely absorbed, and tuberculous nodules >3 mm could be completely absorbed or the lesions shrank. In 10 patients with increased cisternal exudation, the lesions subsided significantly. In 5 patients with cerebral infarction, no progressive stroke occurred, and the edema around the infarction significantly subsided to a softening lesion. Of the 17 patients with abnormal CSF, 8 had their CSF white blood cell counts recovered to normal, and 9 had CSF parameters improved and stabilized. The median treatment time of thalidomide was 16 (12,16) weeks. All patients stopped thalidomide after intracranial lesions got improved significantly or CSF parameters improved and stabilized. During treatment, 2 patients developed peripheral neuritis which improved after receiving nutritional neurotherapy, and no other adverse events attributable to thalidomide were reported. Conclusion: Low dose thalidomide adjuvant treatment on tuberculous meningitis paradoxical reaction can effectively improve intracranial lesions and CSF parameters of patients, with good safety.

Key words: Tuberculosis, meningeal, Thalidomide, Contradictory reaction, Treatment