Recurrent cervical lymphadenitis caused by Haemophilus aphrophilus.

been reported in the literature and has been termed as a “paradoxical response” [6–8]. Within the first 10 days after starting antituberculous therapy, our patient had significant morbidity due to an unclear mechanism. It is possible that persistent compression of the cerebral cortex by a stable epidural mass was responsible for cerebral venous thrombosis, ischemia, and/or infarction and vasogenic or cytotoxic edema of subjacent white matter, leading to seizures and headache in this 21-year-old man. In addition, a type IV hypersensitivity reaction may have developed within the unchanged abscess, resulting in cerebral vasculitis, infarction, edema, and clinical seizure [9]. The improvement seen during steroid therapy may have been due to a reduction in cerebral edema (i.e., a mechanical effect) and/or to a direct anti-inflammatory mechanism on the cerebral vasculature [10]. However, MRI during this acute phase revealed no change in cerebral edema or in a midline shift to the left. Paradoxical reaction syndrome complicating therapy for M. tuberculosis infection involving the intracranial fossa (other than meningitis) is still ill defined, and the role of preemptive glucocorticosteroid therapy is uncertain. However, early recognition and treatment of this complication with systemic corticosteroids may result in a more favorable outcome.