Volume 21
Number 2 July 2013Ahmed S N1 , Moula K2 , Daulatuzzaman Md.3
Abstract
Paradoxical reaction (PR) during antituberculous therapy is defined as the clinical or radiological worsening of pre-existing tuberculous lesions or the development of new lesions in a patient who initially improves. This phenomenon is mostly seen in patients with HIV, after Highly Active Antiretroviral Therapy (HAART) has been commenced; however this is also seen in patients who are HIV negative, although the frequency is much less at 2-23% 2-4. The commonest form of PR that we come across in our practice is that of tubercular lymyphadenopathy, where the lymph nodes increase in size before regressing. Various other manifestations have also been mentioned namely worsening of fever, cough, chest infiltrates, new or enlargement of cerebral tuberculomas5-7. Paradoxical worsening of pulmonary lesions, leading to respiratory failure, although rare, are more commonly noted in miliary TB than in non-miliary pulmonary TB among patients without HIV infection.8-10. Ellis and Webb' 1 noted sudden death in the early phase of treatment of miliary Tb, these types of deterioration have been noted with accompanying rise in ESR.
Keywords:
- Assistant Professor of Medicine
- Professor and Head, Department of Medicine
- Professor, Department of ENT