Table 2. Biologics and other immunomodulatory therapies in TBM; summary of published case reports.

Reference	Drug	Dose	Mechanism	Clinical outcome
Blackmore 48	Infliximab	10mg/kg, three doses at monthly intervals	Anti-TNF	Given after four months due to ongoing clinical deterioration, despite treatment with dexamethasone and cyclophosphamide; resulted in clinical improvement.
Jorge 49	Infliximab	10mg/kg, three doses at monthly intervals	Anti-TNF	Young adult with juvenile idiopathic arthritis, treated with infliximab developed disseminated TB. With stopping of infliximab, neurological deterioration occurred with isolation of M.tb in CSF, with no improvement with corticosteroids. Infliximab re- initiation led to neurological improvement.
Molten 50	Infliximab	Case 1: 10mg/kg, three doses at monthly intervals Case 2: 5mg/kg, three doses at six- week intervals	Anti-TNF	Two cases describing paradoxical worsening after initiation of TBM treatment, unresponsive to dexamethasone. In both cases, clinical improvement occurred following administration of infliximab.
Abo 51	Infliximab	5mg/kg, three doses at weeks 1, 3 and 7	Anti-TNF	Paradoxical worsening (optochiasmatic arachnoiditis, leading to loss of vision) on starting TB treatment in a seven-year-old with TBM, despite dexamethasone. Clinical improvement occurred following infliximab administration.
Keeley 53	Anakinra	100 mg subcutaneously daily	Interleukin-1 receptor antagonist	Two cases of steroid dependant neurotuberculosis (paradoxical worsening when steroids stopped). In both cases, patients responded to anakinra therapy.
A. Gonzalez- Duarte 55	Cyclophosphamide	750mg/m 3 every three weeks	Alkylating agent of nitrogen mustard type.2	Clinical improvement
Celloti 54	Cyclophosphamide	750mg/m 3 every three weeks	Alkylating agent of nitrogen mustard type.2	Clinical improvement

TNF, tumor necrosis factor; TB, tuberculosis; M.tb, Mycobacterium tuberculosis; CSF, cerebrospinal fluid; TBM, tuberculous meningitis.