Paradoxical upgrading reaction in extra-pulmonary tuberculosis: association with vitamin D therapy

Barr, David; Coussens, Anna K.; Irvine, Sharon; Ritchie, Neil D.; Herbert, Kirsten; Choo-Kang, Brian; Raeside, David; Bell, David; Seaton, R Andrew

doi:10.5588/ijtld.16.0927

Cited by 15 publications

(9 citation statements)

References 33 publications

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“…It may mediate PR in antituberculosis treatments. 28 The patients in our cases adopted original anti-tuberculosis treatments without corticosteroid since they did not show worsening of the clinical symptoms and their general condition was good. The course of treatments should be based on the patient conditions.…”

Section: Discussionmentioning

confidence: 77%

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

Guo¹,

Guo²,

Song³

et al. 2019

IDR

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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.

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Section: Discussionmentioning

confidence: 77%

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

Guo¹,

Guo²,

Song³

et al. 2019

IDR

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“…Predictive risk factors for paradoxical reaction during treatment for cervical lymph node TB are lymph node size ≥ 3 cm and extralymph node TB (multivariate and univariate analyses), as well as sweating (univariate analysis) [25]. Age, antigenic load, lymphocyte count, inflammatory status, and vitamin D status are also independent risk factors for paradoxical reaction, when under treatment for extrapulmonary TB [22]. Moreover, baseline anemia, hypoalbuminemia, lymphopenia, and a greater change in lymphocyte count are independent risk factors for PR during therapy for pulmonary TB [26].…”

Section: Discussionmentioning

confidence: 99%

Left Lateral Cervical Mass with Draining Sinuses

Michaelides

Bablekos

Michailidis

et al. 2019

Case Reports in Medicine

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The aim of the present study is to describe an uncommon case of tuberculous lymphadenitis (TL) in a symptomless 89-year-old male smoker patient, who presented at the emergency department of our hospital with left lateral cervical swelling with draining sinuses. No other clinical symptoms or physical findings were observed at admission. An elevated erythrocyte sedimentation rate (ESR) and a small calcified nodule in chest CT were the only abnormal findings. Pus samples from sinuses were examined and confirmed tuberculosis which was in agreement with surgical pathology of lymph nodes. A four- (4-) drug antituberculous regimen was administered. After an initial remission of his symptoms, the patient presented an exacerbation of the cervical swelling with draining sinuses necessitating addition of oral steroids. TL can be symptomless presenting a paradoxical reaction during treatment. The uniqueness of our case lies in the patient’s advanced age, which is uncommon with cervical lymphadenopathy as a form of extrapulmonary tuberculosis, as well as in the administration of oral steroids to resolve the neck’s clinical deterioration. The patient had a complete recovery and was free of disease after completion of his six-month antituberculous chemotherapy.

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“…Bei mediastinaler Lymphknotentuberkulose findet sich i. d. R. eine adäquate Rückbildung der Lymphknoten unter Therapie. Bei zervikalem Lymphknotenbefall werden z. T. protrahierte Verläufe beobachtet, die auch unter antituberkulöser Therapie mit fortbestehender Fistelbildung oder einem Progress der Lymphome (in ihrer Größe und/oder Anzahl) einhergehen können [116]. Eine Therapie mit Prednisolon kann bei Größenzunahme der Lymphknoten zum Rückgang führen, einschmelzende und fistelnde Lymphknoten können nach chirurgischer Therapie und VAC-Therapie (vacuum assisted closure therapy) unter Fortführung der medikamentösen Therapie ausheilen [117].…”

Section: Verlaufunclassified

Tuberkulose im Erwachsenenalter

et al. 2022

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ZusammenfassungDie Tuberkulose ist in Deutschland eine seltene, überwiegend gut behandelbare Erkrankung. Weltweit ist sie eine der häufigsten Infektionserkrankungen mit ca. 10 Millionen Neuerkrankungen/Jahr. Auch bei einer niedrigen Inzidenz in Deutschland bleibt Tuberkulose insbesondere aufgrund der internationalen Entwicklungen und Migrationsbewegungen eine wichtige Differenzialdiagnose. In Deutschland besteht, aufgrund der niedrigen Prävalenz der Erkrankung und der damit verbundenen abnehmenden klinischen Erfahrung, ein Informationsbedarf zu allen Aspekten der Tuberkulose und ihrer Kontrolle. Diese Leitlinie umfasst die mikrobiologische Diagnostik, die Grundprinzipien der Standardtherapie, die Behandlung verschiedener Organmanifestationen, den Umgang mit typischen unerwünschten Arzneimittelwirkungen, die Besonderheiten in der Diagnostik und Therapie resistenter Tuberkulose sowie die Behandlung bei TB-HIV-Koinfektion. Sie geht darüber hinaus auf Versorgungsaspekte und gesetzliche Regelungen wie auch auf die Diagnosestellung und präventive Therapie einer latenten tuberkulösen Infektion ein. Es wird ausgeführt, wann es der Behandlung durch spezialisierte Zentren bedarf.Die Aktualisierung der S2k-Leitlinie „Tuberkulose im Erwachsenenalter“ soll allen in der Tuberkuloseversorgung Tätigen als Richtschnur für die Prävention, die Diagnose und die Therapie der Tuberkulose dienen und helfen, den heutigen Herausforderungen im Umgang mit Tuberkulose in Deutschland gewachsen zu sein.

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Paradoxical upgrading reaction in extra-pulmonary tuberculosis: association with vitamin D therapy

Cited by 15 publications

References 33 publications

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

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

Left Lateral Cervical Mass with Draining Sinuses

Tuberkulose im Erwachsenenalter

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