<p>Paradoxical Reaction In The Form Of New Pulmonary Mass During Anti-Tuberculosis Treatment: A Case Series And Literature Review</p>

Abstract

Introduction: Paradoxical reaction refers to deterioration of the original tuberculosis lesions or emergence of new infiltrative lesions during anti-tuberculosis treatment. The common manifestations of paradoxical reaction include new pleural effusion, cerebral tuberculosis and lymphadenitis. Paradoxical reaction manifested by new pulmonary mass is rare. Patients and methods: This article summarizes and analyzes the clinical manifestations, chest CT, laboratory findings, treatments, pathological biopsy results of five patients diagnosed as paradoxical reaction in the form of new pulmonary mass. A literature review related to paradoxical reaction was conducted. Results: Five patients diagnosed as pulmonary tuberculosis or tuberculous pleuritis received systematic anti-tuberculosis treatmensssts. New pulmonary masses were found by CT scans during the follow-ups. The patients were negative for tumor markers, examination of rheumatoid connective tissue disease and G/GM test. The original anti-tuberculosis treatments were continued. All of the masses were diminished gradually. Conclusion: Paradoxical reaction needs to be taken into consideration when a new pulmonary mass occurs during anti-tuberculosis treatments. The diagnosis should be based on the patients' clinical manifestations, laboratory results, imaging examinsssations and lung biopsy examinations. The original anti-tuberculosis therapy can be continued in patients without severe clinical symptoms. A close follow-up is needed.

Analysis of risk factors for pulmonary tuberculosis with persistent severe inflammation

“…Autoimmune inflammation in a large cavity might be related to a paradoxical reaction; only 1 patient with persistent severe inflammation in our study was identified as having a paradoxical reaction based on the worsening of existing disease or new TB lesions, with other diseases ruled out during antituberculous therapy. [ 15 ] Paradoxical reactions include recurring symptoms, such as fever, and radiological deterioration occurring from 1 week to several months after the initiation of antituberculous treatment. [ 15 ] Rapid killing of bacilli with antibiotics may lead to the release of large amounts of microbial components, which can stimulate a strong inflammatory response.…”

“…[ 15 ] Paradoxical reactions include recurring symptoms, such as fever, and radiological deterioration occurring from 1 week to several months after the initiation of antituberculous treatment. [ 15 ] Rapid killing of bacilli with antibiotics may lead to the release of large amounts of microbial components, which can stimulate a strong inflammatory response. [ 15 ] A previous report found a median CRP level of 4.5 mg/dL (IQR 2.8–7.4) in patients with paradoxical reactions, [ 16 ] for which steroid therapy is recommended for management.…”

“…[ 15 ] Rapid killing of bacilli with antibiotics may lead to the release of large amounts of microbial components, which can stimulate a strong inflammatory response. [ 15 ] A previous report found a median CRP level of 4.5 mg/dL (IQR 2.8–7.4) in patients with paradoxical reactions, [ 16 ] for which steroid therapy is recommended for management. [ 15 ] Autoimmune inflammation, which might be induced by TB bacilli in a large cavity, is similar to the paradoxical reaction mechanism; therefore, steroid therapy might affect persistent severe inflammation.…”

“…[ 15 ] A previous report found a median CRP level of 4.5 mg/dL (IQR 2.8–7.4) in patients with paradoxical reactions, [ 16 ] for which steroid therapy is recommended for management. [ 15 ] Autoimmune inflammation, which might be induced by TB bacilli in a large cavity, is similar to the paradoxical reaction mechanism; therefore, steroid therapy might affect persistent severe inflammation. [ 15 ] In our study, one patient received steroid therapy for persistent severe inflammation, and the patient's CRP level and fever rapidly improved.…”

“…[ 15 ] Autoimmune inflammation, which might be induced by TB bacilli in a large cavity, is similar to the paradoxical reaction mechanism; therefore, steroid therapy might affect persistent severe inflammation. [ 15 ] In our study, one patient received steroid therapy for persistent severe inflammation, and the patient's CRP level and fever rapidly improved. If autoimmune inflammation occurs in a patient with persistent severe inflammation, steroid therapy might be considered.…”