Page 351 - Abstract Book KONIKA 18

Neurology

P-NEU-029
Paradoxical Reaktion in Non-HIV Tuberculous Meningitis

Pandu Caesaria Lestari, Citra Raditha, Anna Tjandrajani
Department of Child Health, PKIAN RSAB Harapan Kita, Jakarta, Indonesia

Abstract
Background Paradoxical reaction is a worsening condition that occur in patients with tuberculosis who
received antituberculosis. The development of clinical deterioration may need meticulous approach since the
cause of the condition worsening may vary to treatment failure, until inaccuracy diagnosis. It could happen
to non-HIV infection as well as HIV infected patient. Objective To demonstrate a rare case of paradoxical
reaction in tuberculous meningitis happened in non-HIV patient. Case Patients is a 14-year-old boy who
had tuberculous meningitis and admitted due to altered mental status, disorientation, and focal seizure in his
right extremities while on 1 month antituberculosis and recently had prednisone tapered off. The physical
st
examination revealed no cranial nerve abnormalities, but positive meningeal sign. His CSF analysis showed
improvement in protein and cells 140 mg/dL and 48 cell/uL, and no mycobacterium tuberculosis on NAAT
examination. But his MRI showed small multiple tuberculoma and worsen of enhancement in bilateral basal
cisternal and left fissure Sylvii. His chest x-ray showed new right pleural effusion. His prednisone dose was
increased again, and phenytoin was given. The condition improved and his prednisone was given until 3
months, and taper off slowly. From the follow up 1 year later, his cognitive examination was normal and EEG
normal. Antituberculosis and antiepileptic was stopped. Conclusion In tuberculous meningitis responsive to
treatment, deterioration condition is caused by rapidly growing immune system after antituberculosis agent
was given. The use of prednisone more than 1 month may help to relieve the symptoms.
Keywords: tuberculous meningitis; paradoxical reaction

P-NEU-030
A Case Series of Pediatric Ocular Myasthenia Gravis

Cynthea Prima Destariani, Hardiono D. Pusponegoro, Irawan Mangunatmadja, Setyo Handryastuti,
Amanda Soebadi, Achmad Rafli
Department of Child Health, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo General Hospital,
Jakarta, Indonesia

Background Ocular Myasthenia Gravis (OMG) is a disease subtype characterized by weakness of extraocular
muscles, eyelid elevator and orbicular muscle. It is characterized by having variable pattern over the
involved muscles, and its initial sign is ptosis. Objective To report case series of OMG in a 2-year-old girls.
Cases Two 2 years old girls came to Cipto Mangunkusumo General Hospital. First case has main complaint
bilateral eyelid weakness in two months without other associated symptoms. The second case has same
complaint in three months. On their physical examination, the patients seen with a compensating position
of the head with chin elevation, visual activity were normal, 5mm palpebral opening, 8mm elevator function
in the first case and 3mm palpebral opening, 5mm elevator function in the second case. The eyes movement
were normal. The ice-pack test was performed, resulting in a slight improvement of the ocular opening. In first
case, anti acetylcholine (AchR) antibodies were elevated and the second case was normal. Pyridostigmine was
administered in low dose in a week but no improvement on both cases. In first case we increased the doses
until maximum dose, the patient presented a significant improvement of the symptoms. Second case, until
maximum dose we didn’t get improvement, and we gave corticosteroid 1mg/bodyweight/day in two weeks,
patient got improvement of the symptoms. Conclusion OMG is a rare disease in pediatric population. Early
diagnosis and commencement of treatment is important to slow the progression of the disease.
Keywords: ocular myasthenia gravis; pyridostigmine; corticosteroids; outcomes

KONIKA XVIII Abstract Book 303