Tuberc Respir Dis.  2008 Jun;64(6):427-432.

Paradoxical Response Developed during the Antituberculous Treatment in Tuberculous Pleurisy

• Song EJ
• Baek DH
• Jung JY
• Lee SR
• Lee MH
• Lee SH
• Lee JH
• Lee KD
• Lee BH
• Kim SH

Abstract

BACKGROUND
A paradoxical response is defined as the radiological and clinical worsening of a previous lesion or the development of new lesion after initial improvement during theprocess of antituberculous treatment. The related factors for the development of a paradoxical response in patients with tuberculous pleurisy are not certain.
METHODS
We selected patients with tuberculous pleurisy who had been treated for more than 4 months. The changes onthe serial chest X-ray findings before and after treatment were reviewed. Paradoxical responses were regarded as any worsening or development of new lesion at least 2 weeks after the initiation of treatment. The baseline clinical characteristics and laboratory findings of the peripheral blood and pleural fluid were compared between the patients with a paradoxical response and the patients without a paradoxical response.
RESULTS
Paradoxical responses appeared in sixteen patients (21%) among the 77 patients.It took a mean of 38.6 days after the treatment and the time to resolve the paradoxical response was a mean of 32.1 days. For the patients with a paradoxical response, the median age was younger (30.5 years vs 39.0 years, respectively) and the lymphocytic percentage of white blood cells in the pleural fluid was higher (82.1% vs 69.6%, respectively) than for the patients without a paradoxical response.
CONCLUSION
The development of a paradoxical response during the treatment of patients with tuberculous pleurisy was not rare and this was related with the age of the patients and the percentage of lymphocytic white blood cells in the pleural fluid.

Keyword

Tuberculous pleurisy; Paradoxical response; Antitubercular agents

MeSH Terms

Antitubercular Agents
Humans
Leukocytes
Thorax
Tuberculosis, Pleural
Antitubercular Agents

Figure

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  Figure 1 Comparison of age (A) and lymphocytic percentage in pleural fluid (B) between patients with paradoxical response and without paradoxical response. Both comparisons showed significant difference (p<0.05). Horizontal bars mean median value (A) and mean value (B). PR: paradoxical response.

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