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Case Report
Paradoxical response as a cervical lymph node enlargement after termination of anti-tuberculosis treatment in a patient with pulmonary tuberculosis - Hye-Rim Kang1, Ho Young Lee1, Mi-Yeong Kim1, Young Min Lee1, Soo Jin Jung2, Hyun-Kyung Lee1, Si Hyeong Lee1, Yunmi Kim1
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Kosin Medical Journal 2016;31(1):71-78.
DOI: https://doi.org/10.7180/kmj.2016.31.1.71
Published online: February 4, 2016
1Department of Internal Medicine, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
2Department of Pathology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
- Corresponding Author: Hyun-Kyung Lee, Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Busan Paik Hospital, College of Medicine, Inje University, Bokji-ro 75, Busangjin-gu, Busan, 47392, Korea Tel.: +82-51-890-8619 Fax: +82-51-892-0273 E-mail: goodoc@gmail.com
• Received: July 9, 2015 • Revised: August 21, 2015 • Accepted: September 7, 2015
Copyright © 2016 Kosin University School of Medicine Proceedings
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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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.
Fig. 1.Posteroanterior (A) and left lateral (B) chest radiograph shows irregular linear opacities in left upper lung field.
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.
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)
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XML DownloadParadoxical response as a cervical lymph node enlargement after termination of anti-tuberculosis treatment in a patient with pulmonary tuberculosis
Fig. 1. Posteroanterior (A) and left lateral (B) chest radiograph shows irregular linear opacities in left upper lung field.
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.
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)
Fig. 1.
Fig. 2.
Fig. 3.
Paradoxical response as a cervical lymph node enlargement after termination of anti-tuberculosis treatment in a patient with pulmonary tuberculosis
