Chien J W, Johnson J L
Department of Medicine, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Ohio 44106-5083, USA.
Chest. 1998 Sep;114(3):933-6. doi: 10.1378/chest.114.3.933.
We present a case of paradoxical clinical deterioration during antituberculosis therapy in an HIV-infected adult with pulmonary TB. The clinical course was characterized by marked cervical and mediastinal adenopathy accompanied by fever and weight loss during simultaneous treatment of TB and HIV disease. After extensive investigation for causes of therapeutic failure, the paradoxical reaction was attributed to partial immune reconstitution related to highly effective antiretroviral therapy. Due to the high prevalence of TB in HIV-infected patients, it is important to recognize this phenomenon and understand that it is usually self-limited.
我们报告了1例感染HIV的成年肺结核患者在抗结核治疗期间出现矛盾性临床恶化的病例。该患者的临床病程特点为，在同时治疗结核病和HIV疾病期间，出现明显的颈部和纵隔淋巴结肿大，并伴有发热和体重减轻。在对治疗失败的原因进行广泛调查后，这种矛盾反应被归因于与高效抗逆转录病毒治疗相关的部分免疫重建。鉴于HIV感染患者中结核病的高流行率，认识到这一现象并了解其通常为自限性很重要。
