Korean J Gastroenterol.  2015 May;65(5):306-311. 10.4166/kjg.2015.65.5.306.

A Case of Paradoxical Reaction Development during Antituberculosis Therapy

• Cho YB
• Chu MS
• Ryu HS
• Choi SC
• Seo GS

• KMID: 2373227
• DOI: http://doi.org/10.4166/kjg.2015.65.5.306

Abstract

Paradoxical reaction during antituberculosis therapy is defined as aggravation of preexisting tuberculous lesions or the development of new lesions. A 24-year-old female college student diagnosed with abdominal and pulmonary tuberculosis presented with fever and abdominal pain after having been treated with antituberculosis agents for 4 months. Tuberculous mesenteric lymphadenitis was suspected on abdominal CT scan and enlarged necrotic abscess was also present. These findings were considered to be due to paradoxical reaction rather than treatment failure during antituberculosis treatment. Although laparoscopic bowel adhesiolysis and abscess drainage were performed, high fever and severe abdominal pain did not improve. However, the patient eventually made a completely recovery after corticosteroid therapy combined with antituberculosis agents. Herein, we report a case of paradoxical reaction which developed in a patient with abdominal and pulmonary tuberculosis during antituberculosis therapy.

Keyword

Paradoxical reaction; Peritonitis, tuberculous; Tuberculosis, pulmonary; Corticosteroid

MeSH Terms

Abscess
Adrenal Cortex Hormones/therapeutic use
Antitubercular Agents/*therapeutic use
Drainage
Female
Humans
Mesenteric Lymphadenitis/etiology
Tomography, X-Ray Computed
Tuberculosis/*drug therapy/pathology
Tuberculosis, Pulmonary/diagnosis/pathology
Young Adult
Adrenal Cortex Hormones
Antitubercular Agents

Figure

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  Fig. 1. Chest CT findings. (A) Chest CT shows ill-defined patchy consolidation and small nodules in the right upper lobe. (B) Four months after initiation of antituberculosis therapy, previous lesion is markedly reduced.

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  Fig. 2. Abdominal CT findings. (A) About 1-cm sized lymphadenopathy with multiple lymphadenopathies is noted on the ileocecal area (arrow).(B) Four months after initiation of antituberculosis treatment, about 4-cm sized conglomerated lymph node with central necrosis is detected on the ileocecal area (arrow). (C) One month after laparoscopic drainage and adjuctive corticosteroid therapy, the conglomerated mass is reduced (arrow). (D) One year after laparoscopic drainage and adjuctive corticosteroid treatment, the previous lesion is decreased to normal range.

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  Fig. 3. Colonoscopic and microscopic findings. (A) Exudate covered shallow ulcer is shown on terminal ileum. (B) Presence of chronic granuloma with epithelioid cells (arrows) is compatible with intestinal tuberculosis (H&E stain, ×200).

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  Fig. 4. Histological finding of peritoneal wall. Peritoneal biopsy shows chronic granulomatous inflammation with epithelioid cell (arrows) and necrosis (asterisk), consistent with tuberculous peritonitis (H&E stain, ×200).

Reference

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