rifampin and Spinal-Cord-Diseases

Topics: Adult; Antitubercular Agents; Diagnosis, Differential; Drug Therapy, Combination; Humans; Isoniazid; Magnetic Resonance Imaging; Male; Mycobacterium tuberculosis; Rifampin; Spinal Cord Diseases; Tuberculoma; Tuberculosis, Spinal

A male patient with tuberculous lymphadenopathy was treated with a four-fold therapy of ethambutol, isoniacide, rifampicin and pyracinamide. After 10 weeks the patient suffered from photophobia. Although ethambutol was discontinued vision decreased and visual field defects occurred as well as signs of myelopathy. Isoniacide was then discontinued and in the subsequent phase the vision was slowly restored over a period of 36 months. The combined toxicity of ethambutol and isoniacide seems to have been the main cause of the severe and protracted optic neuropathy.

Topics: Adult; Antitubercular Agents; Disease Progression; Drug Therapy, Combination; Ethambutol; Humans; Isoniazid; Male; Optic Nerve Diseases; Photophobia; Pyrazinamide; Rifampin; Risk Factors; Risk Management; Spinal Cord Diseases; Treatment Outcome; Tuberculosis, Lymph Node

The author describes the successful medical management of intramedullary tuberculous lesions in four patients who received treatment between 1994 and 1997. The role of magnetic resonance imaging and the treatment protocol for intramedullary tuberculous lesions are also discussed.

Topics: Adolescent; Adult; Antibiotics, Antitubercular; Antitubercular Agents; Clinical Protocols; Female; Follow-Up Studies; Humans; Isoniazid; Magnetic Resonance Imaging; Male; Pyrazinamide; Rifampin; Spinal Cord Diseases; Streptomycin; Tuberculoma; Tuberculosis, Central Nervous System; Tuberculosis, Meningeal; Tuberculosis, Pulmonary

Although there have been reports of Brucella granuloma or abscess in the literature, they were all localized extradurally except one, and most patients underwent surgery.. A 40-year-old female presented with urinary and fecal incontinence and a two-month history of progressive weakness of the right leg and numbness of the left leg. Four months previously, she had been diagnosed with systemic brucellosis with a period of radiculomeningoencephalitis; she was treated successfully with rifampicin, doxycycline, trimethoprim/sulfamethoxazole (TMP/SMZ), and streptomycin, and was discharged symptom-free on rifampicin and doxycycline. Neurological examination revealed spastic paraparesis, globally hyperactive deep tendon reflexes (DTRs) and sensory level at T6. Magnetic resonance imaging (MRI) of the spinal cord revealed a 10 x 30 mm intradural-intramedullary mass lesion at the T5 level with surrounding edema that enhanced with contrast. The cerebrospinal fluid (CSF) was xanthochromic with lymphocytic pleocytosis and elevated levels of albumin, immunoglobulins, and antibody titers for Brucella. The medications were modified to rifampicin 1200 mg, doxycycline 400 mg, and TMP/SMZ 480/2400 mg daily, and methylprednisolone 100 mg in decremental doses (for 6 weeks). After 2 months, the patient was almost symptom-free and her medication doses were decreased. After 5 months, the mass lesion resolved almost completely. The treatment was discontinued after 2 years.. The case is presented because of its uniqueness. In cases of Brucella granuloma, the authors recommend a trial of medical treatment with adequate dosages for a reasonable length of time before considering surgical intervention.

Topics: Adult; Brucellosis; Dose-Response Relationship, Drug; Doxycycline; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; Granuloma; Humans; Magnetic Resonance Imaging; Methylprednisolone; Neurologic Examination; Rifampin; Spinal Cord; Spinal Cord Diseases; Thoracic Vertebrae; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination