Late paradoxical lymph node enlargement during and after anti-tuberculosis treatment in non-HIV-infected patients

Sn, Yu; Oh, Cho Rong; Kh, Park; Jung, Jiwon; Yk, Kim; Jy, Lee; Yp, Chong; So, Lee; Choi, Sung‐Woon; Ys, Kim; Jh, Woo

doi:10.5588/ijtld.15.0257

Cited by 13 publications

(15 citation statements)

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“…The reaction occurs in up to 30% of patients [3,6,7] . Yu et al [5] retrospectively reviewed the medical records of 467 non-HIV-infected patients with lymph node TB between 1997 and 2007, and prospectively enrolled patients with newly diagnosed lymph node TB between 2008 and 2013. Eighty-three (18%) patients had PRs.…”

Section: Discussionmentioning

confidence: 99%

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Multifocal Tuberculosis with Prolonged Paradoxical Reaction

Al-Ebrahim

Madani

2019

JKAU Med Sci

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This is a case report describing successful treatment of a challenging case of an 18-year old previously healthy high school male student with multifocal tuberculosis involving the spleen and mediastinal and abdominal lymph nodes confirmed by histopathology of splenectomy tissue. The patient initially responded well to antituberculosis therapy with complete resolution of fever and improvement in his general health and weight. However, two months after initiation of anti-tuberculosis therapy, the patient developed paradoxical reaction manifest as recurrence of fever that persisted for five months and was associated with enlargement of lymph nodes. The fever failed to abate with continuation of the same antituberculosis therapy. Despite reassurance that the fever was due to a prolonged paradoxical reaction, a decision was made by the family to seek advice in another hospital where lymphoma was excluded again by histopathological examination of an excisional lymph node biopsy that revealed caseating granulomatous lymphadenitis and negative tuberculosis stain, culture, and polymerase chain reaction. The patient was continued on anti-tuberculosis therapy and treated with corticosteroids that resulted in complete resolution of fever and subsequent full recovery from his tuberculosis.

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Section: Discussionmentioning

confidence: 99%

“…Its timing, severity and duration are unpredictable. It may occur anytime during treatment and sometimes even after completing the anti-tuberculosis therapy [4][5][6][7] .…”

Section: Introductionmentioning

confidence: 99%

Multifocal Tuberculosis with Prolonged Paradoxical Reaction

Al-Ebrahim

Madani

2019

JKAU Med Sci

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“…The remarkable feature of our case was that PRs had not occurred for 10 years after the completion of anti-TB drugs. A literature review indicated a high propensity of PRs for CNS involvement in comparison to other sites [ 5 , 13 ], and the time of onset of PRs in CNS tuberculosis appears to be longer than the time of onset at other sites [ 1 , 13 ]. These findings may be attributed to frequent brain MRI and/or CT scans conducted for patients with CNS lesions, considering the nature of these lesions, which are likely to result in the manifestation of symptoms leading to disease progression.…”

Section: Discussionmentioning

confidence: 99%

“…Paradoxical reactions (PRs) to anti-tuberculosis (anti-TB) drugs are defined as the worsening of pre-existing tuberculous lesions or the appearance of new tuberculous lesions in patients whose clinical symptoms initially improved with anti-TB treatment [ 1 – 6 ]. PRs have been reported in approximately one-third of patients with tuberculous meningitis and typically present within the first few months of the anti-TB treatment [ 4 , 5 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Late-onset paradoxical reactions 10 years after treatment for tuberculous meningitis in an HIV-negative patient: a case report

et al. 2018

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BackgroundAlthough paradoxical reactions (PRs) to anti-tuberculosis (anti-TB) therapy during treatment are well-established occurrences, PRs presenting as a new lesion after the completion of treatment are extremely rare, and little is known about the management of such cases, particularly of central nervous system (CNS) tuberculosis.Case presentationA 27-year-old female, with a past medical history of tuberculous meningitis 10 years ago and who completed the anti-TB treatment with asymptomatic remnant tuberculomas in the basal cistern, was admitted to our hospital because of a headache and the worsening of pre-existing visual disturbance. Contrast-enhanced T1-weighted brain magnetic resonance imaging (MRI) revealed new tuberculomas in the left sylvian fissure with a diffuse low signal around it. Because repeated polymerase chain reaction and Mycobacterium tuberculosis culture presented negative results and the patient had no laboratory data suggestive of a relapse of tuberculous meningitis, she was diagnosed with late-onset post-treatment PRs and treated with oral corticosteroids, tapered off over 1 year. Eventually, the symptoms were relieved, and the tuberculomas disappeared.ConclusionsClinicians should consider the possibility of PRs long after the completion of tuberculous meningitis treatment. Hence, a precise MRI-based examination is imperative for the follow-up of CNS tuberculosis, and the unnecessary administration of anti-TB drugs should be avoided. The use of corticosteroids as a treatment option for post-treatment PRs is seemingly safe when the isolated M. tuberculosis is sensitive to the first-line anti-TB therapy.

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“…Bei Patienten/-innen mit einer pulmonalen Tuberkulose tritt eine PR selten (< 3 %) auf [49]. Jedoch zeigen einige Studien, dass die Prävalenz der PR bei extrapulmonalen Tuberkulosen im Schnitt nach 2 Monaten bei etwa 18-25 % liegt [50][51][52]. Besonders häufig scheinen Lymphknotentuberkulosen davon betroffen zu sein.…”

Section: Therapieunclassified

Herausforderungen in der Diagnostik der Darmtuberkulose – Pitfalls einer vergessenen infektiösen Erkrankung: Eine Fallserie und Literaturübersicht

et al. 2019

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ZusammenfassungDie Darmtuberkulose ist eine extrapulmonale Manifestation einer Infektion mit Mykobakterien des Tuberkulosekomplexes. Sie ist in den Industrieländern äußerst selten geworden, präsentiert sich mit einer sehr heterogenen, unspezifischen Klinik und ist schwer zu diagnostizieren. Anders als bei der pulmonalen Tuberkulose besitzen die wichtigsten diagnostischen Methoden wie der Nachweis säurefester Stäbchen in der Ziehl-Neelsen-Färbung, der Genomnachweis mittels PCR-Untersuchung und die kulturelle Anzüchtung der Bakterien eine geringe Sensitivität. Wir präsentieren hier die Fälle von drei Patienten/-innen, bei denen wir eine Darmtuberkulose diagnostizierten und erfolgreich behandelten. An die Fallberichte anschließend stellen wir eine Literaturübersicht vor, die die Fallstricke der Darmtuberkulosediagnostik und -therapie beleuchtet.

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Late paradoxical lymph node enlargement during and after anti-tuberculosis treatment in non-HIV-infected patients

Cited by 13 publications

References 0 publications

Multifocal Tuberculosis with Prolonged Paradoxical Reaction

Multifocal Tuberculosis with Prolonged Paradoxical Reaction

Late-onset paradoxical reactions 10 years after treatment for tuberculous meningitis in an HIV-negative patient: a case report

Herausforderungen in der Diagnostik der Darmtuberkulose – Pitfalls einer vergessenen infektiösen Erkrankung: Eine Fallserie und Literaturübersicht

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