To evaluate the role of pulse methylprednisolone in children with vasculitis with tubercular meningitis (TBM)

Vasculitis in TBM is a major determinant of mortality and long-term morbidity due to cerebral infarcts and stroke. In addition to anti-tubercular therapy, pulse methylprednisolone may result in a favorable outcome in vasculitis in Tubercular meningitis

An ambispective study was done for children aged one month to 18 years diagnosed with TBM who presented to our tertiary care center for a period of 4 years. The outcomes of children with vasculitis who received pulse methylprednisolone and who did not receive pulse methylprednisolone were compared

Over the study period, 33 children were diagnosed with TBM. 19 (57.6%) were females, and 14 (42.4%) were males. 3 (10%), 20(60%), and 10(30%) children had stages 1, 2, and 3 of TBM, respectively. Neuroimaging findings of basal exudates (24), arachnoiditis (8), vasculitic infarcts (22), hydrocephalus (24), and cranial nerve enhancements (12) were seen. Among the 22 children with vasculitis, 13 received oral steroids, and nine received pulse methylprednisolone followed by oral steroids. The degree of disability assessed with the Modified Rankin Scale (mRS) among the 13 who did not receive pulse methylprednisolone was – 5(mRS – 0), 1(mRS – 2), and 7(mRS – 6), and those who received was 4(mRS – 0), 2(mRS – 3) and 3(mRS – 6)

In children with vasculitis in TBM, pulse methylprednisolone may confer a mortality benefit. Larger multicentric randomized controlled trials are warranted further to explore the role of pulse methylprednisolone in TBM vasculitis