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Recovery of Vision After Adjuvant Thalidomide in a Child With Tuberculous Meningitis and Acute Lymphoblastic Leukemia

Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University and Tygerberg Children's Hospital, Cape Town, South Africa, cs{at}sun.ac.za

Savvas Andronikou, MBBCh, FCRad, FRCR, PhD

Department of Radiology, Faculty of Health Sciences, Stellenbosch University and Tygerberg Children's Hospital, Cape Town, South Africa

Nicola Freeman, MBChB, FCOphth

Department of Ophtalmology, Faculty of Health Sciences, Stellenbosch University and Tygerberg Children's Hospital, Cape Town, South Africa

Johan Schoeman, MMed Paed, FCP Paed, MD

Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University and Tygerberg Children's Hospital, Cape Town, South Africa

A 7-year-old child, on maintenance chemotherapy for acute lymphoblastic leukemia, developed tuberculous meningitis complicated by progressive basal meningeal inflammation and abscess formation, in spite of adequate tuberculosis treatment and adjunctive corticosteriod therapy. The child became blind as a result of involvement of the optic chiasm. After 2 months of adjunctive thalidomide therapy, the child regained vision and cranial magnetic resonance imaging showed marked reduction of the inflammatory changes previously demonstrated. Progression of intracranial tuberculous infection, in spite of a treatment that is generally considered to be adequate, is well recognized. Previous reports of a possible beneficiary role of thalidomide in these cases support an immunological basis. The present case suggests a role for thalidomide in the treatment of blindness due to involvement of the optic chiasm in progressive basal tuberculous meningitis.

Key Words: acute lymphoblastic leukemia • tuberculous meningitis • loss of vision • brain abscess • thalidomide

Journal of Child Neurology, Vol. 24, No. 2, 166-169 (2009)
DOI: 10.1177/0883073808322329


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