Ring enhancing lesion in brain and decreasing interferon gamma release assay response

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Clinical Problem:

Ira Shah
Medical Sciences Department, Pediatric Oncall, Mumbai, India

Address for Correspondence: Dr Ira Shah, 1, B Saguna, 271, B St Francis Road, Vile Parle {W}, Mumbai 400056

A 14 years old boy had recurrent right focal convulsions for past 3 years. MRI brain in December 2013 showed neurocysticercosis stage II in left high parietal region for which he was treated with albendazole and steroids. In July 2014, a repeat MRI brain showed same size of granuloma. His EEG and video EEG was normal. There was history of multi-drug resistant {MDR} tuberculosis {TB} in 2 siblings of which one died in 2012 and the other was on treatment for same for the past 1½ years. In view of contact with TB, a CSF TB PCR was done which was negative. Mantoux test was negative. Quantiferon Gold test was positive {3.19}. This child was not started on ATT and advised regular follow up. In December 2014, the repeat MRI showed decrease in size of granuloma and Quantiferon gold has decreased to 0.72.

How reliable is interferon gamma release assays {IGRA} for monitoring disease_?

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