Late-onset paradoxical response 11 years after treatment of tuberculous hepatic abscesses in an HIV-negative patient: a case report and literature review.

Paradoxical responses (PRs) to anti-tuberculosis (anti-TB) treatment refer to the worsening of pre-existing tuberculous lesions or the emergence of new lesions in patients whose clinical symptoms initially improved with therapy. PRs are less common in HIV-negative patients, and presentations as tuberculous hepatic abscesses are rare. Furthermore, PRs occurring after completion of TB treatment are uncommon, making it difficult to distinguish them from TB relapse. We report herein a case of late-onset post-treatment PR, presenting 11 years after completion of treatment for a tuberculous hepatic abscess in an HIV-negative patient. A 51-year-old HIV-negative woman undergoing maintenance hemodialysis, with a history of pulmonary TB with hepatic and splenic abscesses, completed anti-TB treatment 11 years earlier. She was hospitalized after multiple liver nodules were detected on computed tomography. Suspecting a tuberculous hepatic abscess due to TB relapse or PR, we performed an ultrasound-guided liver biopsy. Histopathological analysis revealed epithelioid granulomas with caseous necrosis. However, both polymerase chain reaction and culture for TB were negative. She was therefore diagnosed with late-onset post-treatment PR and carefully observed without treatment. The liver abscesses eventually regressed spontaneously. This case highlights the importance of considering PRs even long after TB treatment completion and underscores the need to avoid unnecessary administration of anti-TB drugs.