Pharmaceutical Care Department, King Abdulaziz Medical City, PO Box 9515, Jeddah, 21423, Saudi Arabia.
King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
BMC Infect Dis. 2024 Oct 21;24(1):1186. doi: 10.1186/s12879-024-10077-w.
A paradoxical reaction (PR) during the treatment of tuberculosis was defined as the worsening of preexisting disease either clinically or radiologically or the appearance of a new tuberculous lesion. These reactions are frequently observed in patients coinfected with human immunodeficiency virus (HIV) upon the initiation of antiretroviral therapy (ART). Herein, we present a unique case of a paradoxical reaction in a previously healthy 19-year-old female who started anti-tuberculosis treatment for disseminated tuberculosis. Four weeks after treatment initiation, she developed two new swollen masses in her left dorsum of the hand, accompanied by fever and new right submandibular painful lymphadenopathy, with worsening of the preexisting left lower neck lymph node. The patient underwent needle aspiration from her new skin abscess on the dorsum of her left hand, which revealed positive polymerase chain reaction (PCR) for Mycobacterium tuberculosis. Anti-tuberculosis treatment was continued, and the patient fully recovered. We described an unusual presentation of paradoxical reaction manifested by a skin abscess at a site distant from her primary disease in an immunocompetent TB patient, which demonstrated the importance of considering paradoxical reactions in HIV-negative patients who present with worsening signs and symptoms after initial improvement following treatment initiation.
在治疗结核病期间出现的矛盾反应（PR）被定义为原有疾病在临床或影像学上的恶化，或出现新的结核病变。这些反应在开始抗逆转录病毒治疗（ART）时，经常在同时感染人类免疫缺陷病毒（HIV）的患者中观察到。在此，我们报告了一例先前健康的 19 岁女性在开始治疗播散性肺结核后出现矛盾反应的独特病例。治疗开始后 4 周，她的左手背部出现了两个新的肿胀肿块，伴有发热和新的右侧颌下疼痛性淋巴结病，原有左颈下部淋巴结恶化。患者接受了左手背部新皮肤脓肿的针吸，结果显示结核分枝杆菌聚合酶链反应（PCR）阳性。继续进行抗结核治疗，患者完全康复。我们描述了一例不常见的矛盾反应表现，即免疫功能正常的结核病患者在远离原发疾病的部位出现皮肤脓肿，这表明在初始治疗后最初改善后出现症状和体征恶化的 HIV 阴性患者中，需要考虑矛盾反应。
