Kosin Med J.  2016 Jun;31(1):71-78. 10.7180/kmj.2016.31.1.71.

Paradoxical response as a cervical lymph node enlargement after termination of anti-tuberculosis treatment in a patient with pulmonary tuberculosis

• Kang HR
• Lee HY
• Kim MY
• Lee YM
• Jung SJ
• Lee HK
• Lee SH
• Kim Y

• KMID: 2328720
• DOI: http://doi.org/10.7180/kmj.2016.31.1.71

Abstract

A paradoxical response is not uncommon in non-HIV-infected patients, particularly those with extra-pulmonary tuberculosis. It is defined as the radiological and clinical worsening of a previous lesion or the development of new lesion during anti-tuberculosis therapy. The paradoxical response has been attributed to host immunologic reactions, such as a delayed hypersensitivity or a response to mycobacterial antigens. In most reports of paradoxical response, these responses occurred in the same location as a previous lesion. In this patient with pulmonary tuberculosis, cervical lymph node enlargement occurred as a paradoxical response after the completion of anti-tuberculosis treatment. Although the new lesion developed in another location, it could be considered as a paradoxical response based on the negative culture result of acid fast bacilli from the new lesion and drug sensitivity result from initial bronchoalveolar lavage specimen. Therefore we were able to decide on the termination of unnecessary anti-tuberculous treatment. Based on our case, we can conclude that paradoxical response can occur after the termination of anti-tuberculosis therapy even in new site.

Keyword

Diagnosis; Extra-pulmonary tuberculosis; Paradoxical response

MeSH Terms

Bronchoalveolar Lavage
Diagnosis
Humans
Hypersensitivity, Delayed
Lymph Nodes*
Tuberculosis
Tuberculosis, Pulmonary*

Figure

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  Fig. 1. Posteroanterior (A) and left lateral (B) chest radiograph shows irregular linear opacities in left upper lung field.

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  Fig. 2. High-resolution CT image (1.0-mm section thickness) shows irregualr fibronodular opacities in apicopost. segment of the left upper lobe. In high-resolution CT image, mediastinal lymph node enlargement is not observed.

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  Fig. 3. Postoperative histopathology. Chronic granulomatous inflammation with central caseous necrosis (upper half) is noted which is surrounded by epithelioid histiocytes with Langhans giant cell (*) and lymphocytes in outermost layer. (H&E, x 200)

Reference

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