Paradoxical response of intracranial tuberculomas during chemotherapy: an immunologic phenomenon?

Intracranial tuberculomas are rare in developed countries, occurring mostly in non-Caucasian patients. We describe a white Dutch patient with miliary tuberculosis, who was noted to have intracranial tuberculomas on computed tomographic scanning. During antituberculous chemotherapy the systemic tuberculosis was responding satisfactorily, while intracranial tuberculomas developed or enlarged. Although this caused anxiety and led to some changes in chemotherapy, the lesions eventually disappeared. Possible mechanisms of this paradoxical response are discussed.