Bacha S, Khemiri M, Racil H, Hantous S, Chaouch N, Cheikhrouhou S, Chabbou A, Megdiche M L
Service de pneumologie, hôpital Abderrahmane Mami, pavillon 2 Ariana, Tunisie.
Service de pneumologie, hôpital Abderrahmane Mami, pavillon 2 Ariana, Tunisie.
Rev Pneumol Clin. 2016 Dec;72(6):367-372. doi: 10.1016/j.pneumo.2016.09.002. Epub 2016 Oct 21.
The features of paradoxical reactions (PR) that occurred in non-HIV infected patients are rare and not well known.
The authors reported the case of a 21years old, non-immunocompromised, and HIV negative patient treated for disseminated tuberculosis. PR occurred after 8months after initiation of antituberculous treatment. PR presented as left cervical lymphadenopathy, pulmonary, pleural, costal and spinal location of the tuberculosis. The antituberculous drugs were prolonged. Patient's clinical symptoms improved initially. However, left inguinal lymphadenopathy appeared after 20months of antituberculous therapy. Inguinal lymph node biopsy revealed tuberculous lymphadenitis. The patient has a good compliance to the treatment. The patient was continued on same antituberculous treatment for a total of 28months. The cervical and inguinal lymphadenopathy disappeared and CT scan showed regression of thoracic, abdominal, costal and spinal lesions.
PR during antituberculous treatment must be considered after exclusion of other causes. No consensus on the therapeutic management of this entity has been developed to date.
非HIV感染患者发生的矛盾反应(PR)特征罕见且鲜为人知。
作者报告了一名21岁、无免疫功能低下且HIV阴性的播散性结核病患者的病例。PR在抗结核治疗开始8个月后出现。PR表现为左颈部淋巴结病,以及结核在肺部、胸膜、肋骨和脊柱部位的出现。抗结核药物疗程延长。患者临床症状最初有所改善。然而,抗结核治疗20个月后出现左腹股沟淋巴结病。腹股沟淋巴结活检显示为结核性淋巴结炎。患者对治疗依从性良好。患者继续接受相同抗结核治疗,共28个月。颈部和腹股沟淋巴结病消失,CT扫描显示胸部、腹部、肋骨和脊柱病变消退。
抗结核治疗期间的PR在排除其他原因后必须予以考虑。迄今为止,对于该病症的治疗管理尚未达成共识。