Mariño Eduardo, Rodríguez-Pardo Jorge, Vidal Laura, Zmork Gerardo, Garcial-Leal Alicia, Díaz-Pollán Beatriz, Lacruz Laura
Neurology Department and Stroke Center, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital-Universidad Autónoma de Madrid, Madrid, Spain.
Infectious Diseases Unit, Internal Medicine Department, IdiPAZ (La Paz Institute for Health Research), La Paz University Hospital, Madrid, Spain.
Case Rep Infect Dis. 2025 Aug 21;2025:5416948. doi: 10.1155/crdi/5416948. eCollection 2025.
Paradoxical reactions during tuberculosis (TBC) therapy are characterized by clinical or radiological worsening of preexisting tuberculous lesions or the appearance of new manifestations following appropriate TBC treatment. Identifying this phenomenon is crucial, since it can be mistaken with treatment failure or relapse. Although widely described in HIV patients following immune reconstitution inflammatory syndrome, the literature on HIV-negative patients is scarce. We present three cases of immunocompetent patients with central nervous system tuberculosis (CNS-TBC) who developed paradoxical reactions following appropriate TBC therapy. These included diverse clinical and radiological manifestations, such as persistent headaches, apparition or progression of tuberculomas, cerebral infarcts, and dorsal myelitis. Paradoxical reactions occurred within an average of 2.5 months from the start of anti-TBC treatment. Our findings underscore the importance of closely monitoring patients following anti-TBC treatment to identify potential complications rapidly. Paradoxical reactions due to exaggerated immune response to complex antigens should be considered in a thorough differential diagnosis including other CNS infections, granulomatous or neoplastic disorders, treatment failure, or treatment-related toxicities. Ensuring adequate adherence to anti-TBC treatment and immunosuppressants is essential in such cases.
结核病（TBC）治疗期间的矛盾反应表现为，在适当的TBC治疗后，既往结核病灶出现临床或影像学恶化，或出现新的表现。识别这一现象至关重要，因为它可能被误诊为治疗失败或复发。虽然在免疫重建炎症综合征后的HIV患者中对此有广泛描述，但关于HIV阴性患者的文献却很稀少。我们报告了3例免疫功能正常的中枢神经系统结核病（CNS-TBC）患者，他们在接受适当的TBC治疗后出现了矛盾反应。这些反应包括多种临床和影像学表现，如持续性头痛、结核瘤的出现或进展、脑梗死和脊髓炎。矛盾反应平均在抗TBC治疗开始后2.5个月内出现。我们的研究结果强调了在抗TBC治疗后密切监测患者以快速识别潜在并发症的重要性。在全面的鉴别诊断中，包括其他中枢神经系统感染、肉芽肿性或肿瘤性疾病、治疗失败或治疗相关毒性时，应考虑因对复杂抗原的免疫反应过度而导致的矛盾反应。在这种情况下，确保充分坚持抗TBC治疗和使用免疫抑制剂至关重要。
