Kabra Meghana Nathani, Kunapareddy Thrinadh
Department of Internal Medicine, Batra Hospital and Medical Research Centre, New Delhi, India.
Indian J Med Microbiol. 2019 Jul-Sep;37(3):450-453. doi: 10.4103/ijmm.IJMM_18_242.
A paradoxical upgradation response in tuberculosis (TB) is defined as the worsening of a pre-existing tubercular lesion or the appearance of a new lesion in a patient whose clinical symptoms initially improved with anti-TB treatment. A paradoxical response is common in HIV patients in the form of immune reconstitution inflammatory syndrome. A similar kind of response can also be seen in immunocompetent patients. Here, we present two cases of non-HIV TB who initially improved with antitubercular therapy (ATT) but worsened thereafter. After excluding possibilities such as multidrug-resistant TB, treatment failure or a superadded infection, a paradoxical upgradation response was diagnosed. Both the cases improved after treatment with corticosteroids in addition to ATT.
结核病中的矛盾升级反应被定义为，在接受抗结核治疗后临床症状最初有所改善的患者中，先前存在的结核病灶恶化或出现新病灶。矛盾反应在HIV患者中很常见，表现为免疫重建炎症综合征。在免疫功能正常的患者中也可观察到类似的反应。在此，我们报告两例非HIV结核病患者，他们最初接受抗结核治疗（ATT）后病情有所改善，但随后病情恶化。在排除耐多药结核病、治疗失败或叠加感染等可能性后，诊断为矛盾升级反应。两例患者在接受ATT联合皮质类固醇治疗后病情均有改善。
