Adénopathie paradoxale au cours du traitement d’une tuberculose cavitaire chez un malade immunocompétent

Rakotoson, J.L.; Rakotomizao, Jocelyn Robert; Andrianasolo, Radonirina Lazasoa; Rakotoharivelo, H.; Andrianarisoa, A.

doi:10.1016/j.pneumo.2010.11.006

Cited by 6 publications

(4 citation statements)

References 12 publications

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“…[ 6 7 8 ] The delay of occurrence of PR in our observation was two months, which was concordant to the delays described in the literature. [ 3 9 ]…”

Section: Discussionmentioning

confidence: 99%

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Palate Tuberculosis with Paradoxical Lymphadenitis

Kéchaou

Abida

Hamdi

et al. 2021

Journal of Global Infectious Diseases

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Oral cavity involvement in tuberculosis (TB), particularly palatine, is extremely rare and mostly described in case reports. Management of these cases usually responds to classic antitubercular therapy. Some serious complications such as paradoxical reactions (PRs) may however occur, making it more challenging for physicians to treat and to manage. We present a case of a 30-year-old female patient with a history of juvenile idiopathic arthritis and systemic lupus erythematosus who presented a bifocal form of TB involving the palate and the cervical lymph nodes. Follow-up after 2 months of proper antitubercular treatment revealed a PR of the lymph nodes contrasting with a favorable outcome of the oral lesions. It seems useful to raise all clinicians' awareness to suspect TB when they deal with chronic drug-resistant oral erosions and to keep in mind the diagnosis of PR when there is a worsening of one lesion and a favorable outcome of another.

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“…[ 6 7 8 ] The delay of occurrence of PR in our observation was two months, which was concordant to the delays described in the literature. [ 3 9 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 ] Drainage aspiration can be an interesting alternative to surgery but beware of the risk of fistulization and recurrence. [ 9 ]…”

Section: Discussionmentioning

confidence: 99%

Palate Tuberculosis with Paradoxical Lymphadenitis

Kéchaou

Abida

Hamdi

et al. 2021

Journal of Global Infectious Diseases

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“…Another issue to be discussed is the exacerbation of our patient's neck growth one month after induction of anti-TB treatment, something which is not an unusual event during therapy of TL, characterized as a paradoxical reaction (PR). Paradoxical reaction is a transitory deterioration of the clinical and/or radiological condition although the patient is under appropriate anti-TB therapy [21–23], and it is interpreted by two different proposed theories: the first lies in a delayed immune activation and the second one in a hypersensitivity reaction to the antigen released from dying mycobacteria [24]. 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].…”

Section: Discussionmentioning

confidence: 99%

“…The use of corticosteroids while receiving therapy for TL seems to resolve paradoxical reaction and improves the clinical outcome [30, 35–39]. Although steroids seem to be particularly effective against paradoxical reaction during appropriate treatment for intracranial tuberculomas [21, 32], TB meningitis [40], and pleural TB [41], another study showed no significant clinical response [42]. The rationale for the use of corticosteroids is based on the reduction of the inflammation process [30].…”

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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