How can tuberculoma be effectively managed with the help of medication?

Question

Hello doctor,

I am a tuberculoma patient for the past year. I had an ill-defined heterogeneous cystic lesion measuring 34 x 27 mm in the right cerebellar hemisphere. My doctor prescribed tablets of Rifampicin and Isoniazid combination, Ofloxacin, Ethambutol, Pyrazinamide, vitamin B6 (Pyridoxine), and Domperidone and Pantoprazole combination. After three months, my doctor stopped Ethambutol. After five months, Pyrazinamide was also discontinued. In the last liver function test (LFT) scan, my ALT (alanine transaminase) increased to 344 and AST (aspartate aminotransferase) to 176, resulting in the discontinuation of Broadbact (Ofloxacin). My doctor advised me to undergo another LFT and MRI (magnetic resonance imaging) scan after one month. The MRI showed a reduction in the lesion size from 34 x 27 mm to 20 x 18 mm. However, after stopping Broadbact, I experienced sickness for almost 15 days, along with stiffness in my neck and headaches in my frontal head, sometimes affecting my right eye and other times my left.

I consulted my doctor, who attributed these symptoms to seasonal effects. In the LFT, ALT was still at 244 and AST at 144, leading to the discontinuation of the Rifampicin and Isoniazid combination and the continuation of Isoniazid, vitamin B6 (Pyridoxine), and Ethambutol. Over the past five months, my recovery has been unstable, with occasional feelings of sickness, fever, and neck stiffness. My question is, will stopping Rifampicin and Isoniazid combination and Ofloxacin affect my recovery? Are they effective in treating TB (tuberculosis) lesions?

Kindly help.

Answer 1

Hello,

I am glad you chose icliniq for your medical-related queries.

I understand your concern. It is a positive indication that the repeat MRI (magnetic resonance imaging) scans showed a decrease in the size of the tuberculoma, nearly half the size compared to before. However, as you mentioned having high ALT or AST levels, could be a side effect of the anti-tubercular medicines. Among the anti-tubercular medicines, Isoniazid, Pyrazinamide, and Rifampicin can cause liver function test (LFT) abnormalities. On the other hand, ethambutol can be continued without interruption. In cases of elevated ALT (alanine transaminase) or AST(aspartate aminotransferase) levels, it is necessary to suspend these medicines until the ALT and AST levels return to normal. After that, each medicine should be reintroduced one by one. For effective treatment after discontinuing a few anti-tubercular medicines, second-line anti-tubercular medicines such as Ofloxacin and others should be added. I am not sure why your doctor stopped Ofloxacin.

I suggest you continue with the following treatment plan:

Tablet Ethambutol, tablet Ofloxacin, and injection Streptomycin (if kidney function test is normal)
Tablet Cycloserine can also be considered until the liver function tests (LFT) levels normalize and other anti-tubercular medicines cannot be added.
Once the LFT levels return to normal, Isoniazid, Rifampicin, and Pyrazinamide can be reintroduced one by one while closely monitoring the LFT levels. Consult your specialist doctor, discuss with them, and take the medicines with their consent.

Hope I have clarified your query.

Thank you.