Possible role of adjunctive thalidomide therapy in the resolution of a massive intracranial tuberculous abscess

We present the case of a young child who developed a massive tuberculous ab scess of the posterior fossa while being treated for pulmonary tuberculosis . Clinical improvement after surgical excision of the abscess was followed by recurrence of symptoms of acutely raised intracranial pressure on standa rd antituberculosis and corticosteroid therapy. Magnetic resonance (MR) ima ging of the brain showed that a multiloculated abscess had developed anteri or to the excision site of the original abscess. The recurring abscess was partly excised and drained but could not be removed completely because of i ts proximity to the brain stem. Thalidomide, a potent inhibitor of tumour n ecrosis factor alpha (TNF-alpha). was added to the treatment regimen and re sulted in marked clinical improvement with resolution of the abscess within 4 months. The remaining CT lesion had the appearance of a small granuloma. Both the clinical and the radiological response was maintained after 1 yea r of antituberculosis treatment.