Case ReportsA Life-Threatening Central Nervous System–Tuberculosis Inflammatory Reaction Nonresponsive to Corticosteroids and Successfully Controlled by Infliximab in a Young Patient With a Variant of Juvenile Idiopathic ArthritisJorge, Jaimes-Hernández MD*; Graciela, Cárdenas MD†; Pablo, Aranda-Pereira MD*; Luis, Soto-Hernández José MD†Author Information From the *Rheumatology Department, Centro Médico ISSEMYM, Toluca; and †Neuroinfectology Department, Instituto Nacional de Neurología y Neurocirugía, Secretaria de Salud, México. The authors declare no conflict of interest. Correspondence: Jaimes-Hernández Jorge, MD, Rheumatology Department, Centro Médico ISSEMYM Toluca, Av. Baja Velocidad 284, San Jerónimo Chicahualco, Metepec, CP 52140, Estado de México. E-mail: email@example.com. Journal of Clinical Rheumatology: June 2012 - Volume 18 - Issue 4 - p 189-191 doi: 10.1097/RHU.0b013e318258b725 Buy Metrics Abstract We report a young patient with a variant of juvenile idiopathic arthritis, who, after 4 years of infliximab treatment, developed miliary tuberculosis (TB) with central nervous system involvement (meningitis and multiple tuberculomas). After anti-TB treatment, clinical and radiologic responses were observed, but severe cerebrospinal fluid and brain inflammatory reaction, nonresponsive to corticosteroids, persisted. It was considered a life-threatening paradoxical reaction based on initial cerebrospinal fluid isolation of Mycobacterium tuberculosis fully sensitive to primary anti-TB drugs. After 4 months in the hospital, infliximab was administered considering that infliximab is a potent tumor necrosis factor α inhibiting agent that participates in the formation and preservation of granulomas and may help to modulate the exaggerated cell-mediated immune response against mycobacterial antigens. Clinical complications associated to brain inflammation resolved, and after 3 years of follow-up, the patient remains self-sufficient without neurologic sequels. © 2012 Lippincott Williams & Wilkins, Inc.