Paradoxical reaction in the form of pleural effusion after onset of anti-tuberculous medication for tubercular lymphadenitis

Bhattacharya, Ambarish; Mukherjee, Suranjan

doi:10.7861/clinmedicine.17-2-143

Cited by 5 publications

(2 citation statements)

References 5 publications

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“…According to the relevant literature, when diagnosis of TL is established and adequate anti-TB regimen is administered, a relapse in adenitis or appearance of draining sinuses could be expected and managed by adding oral steroids along with the anti-TB medication [32], despite steroids not being prescribed for TL treatment [34], except for local discomfort [20]. 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].…”

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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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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“…1 The common clinical manifestation of PR includes recurring symptoms such as fever, cough and polypnea, radiological deterioration, appearance of pleural effusion or ascites, new intracranial tuberculosis and the progression of lymphadenitis. 2 PR can occur from one week to several months after the initiation of anti-tuberculosis treatments. 3,4 It is more frequent in patients with extrapulmonary or disseminated tuberculosis.…”

Section: Introductionmentioning

confidence: 99%

<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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Rifampicin/isoniazid/pyrazinamide/ethambutol

2017

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Paradoxical reaction in the form of pleural effusion after onset of anti-tuberculous medication for tubercular lymphadenitis

Cited by 5 publications

References 5 publications

Left Lateral Cervical Mass with Draining Sinuses

Left Lateral Cervical Mass with Draining Sinuses

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

Rifampicin/isoniazid/pyrazinamide/ethambutol

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