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Abstract Details

Cyclophosphamide therapy as an Adjunct in Refractory Tubercular Arachnoiditis
Infectious Disease
Infectious Disease Posters (7:00 AM-5:00 PM)
022
To investigate cyclophosphamide as a new adjuvant therapy for refractory tubercular arachnoiditis.
Antitubercular therapy (ATT) combined with steroids is mainstay of therapy for tubercular meningitis. Progressive inflammation is a well-recognized complication of tubercular meningitis with clinical manifestations as seizure, paraparesis, hemiparesis, vision loss, hydrocephalus, spinal / opticochiasmatic arachnoiditis leading to serious deficits which causes long term / permanent disability. There is no satisfactory treatment for tubercular arachnoiditis which is refractory to anti-tubercular therapy, corticosteroids and hyaluronidase. 

This was a single institution, retrospective observational study of tubercular meningitis patients with arachnoiditis leading to paraparesis and vision loss. Patients were refractory to standard anti-tubercular therapy, corticosteroids and hyaluronidase. These patients were treated with intravenous cyclophosphamide (dose 500 mg/m2) once a month for 4 consecutive months after informed written consent and were assessed clinically and radiologically before and after cyclophosphamide therapy.
We had 4 patients with refractory tubercular arachnoiditis and three of them became independently ambulatory and was significant clinical as well as radiological improvement in all the patients who received cyclophosphamide as adjuvant therapy. 

In selected cases of TBM when there is refractory arachnoiditis in spite of treatment with ATT, steroids and hyaluronidase, a trial of cyclophosphamide may provide a beneficial effect. Well-designed randomized controlled studies are essential to further evaluate the safety and efficacy of cyclophosphamide in this condition.
Authors/Disclosures
Anand Kumar, MD, DM (Institute of Medical Sciences BHU)
PRESENTER 		Dr. Kumar has nothing to disclose.
Vinay Goyal Goyal, MD, DM, FIAN (Director Neurology) Prof. Goyal has nothing to disclose.
Arunmozhimaran Elavarasi, MD (All India Institute of Medical Sciences) Dr. Elavarasi has stock in Pfizer. Dr. Elavarasi has stock in PGHL. The institution of Dr. Elavarasi has received research support from All India Institute of Medical Sciences, New Delhi. The institution of Dr. Elavarasi has received research support from Indian Council for Medical Research.
Priyanka Samal (All India Institute of Medical Sciences, New Delhi) Ms. Samal has nothing to disclose.