Abstract
IntroductionA paradoxical reaction during antituberculosis treatment is defined as the worsening of pre-existing tuberculosis lesions or the appearance of a new tuberculosis lesion in patients whose clinical symptoms improved with antituberculosis treatment. The median onset time to the development of a paradoxical response has been reported to be about 60 days after the start of treatment. We report the case of a patient with a paradoxical reaction presenting as a psoas abscess after nine months of antituberculosis treatment. To the best of our knowledge, this manifestation has not previously been reported.Case presentationA 23-year-old Japanese man presented to our hospital with lower abdominal pain. Computed tomography showed that he had mediastinal and abdominal para-aortic lymph node swellings. Fluorine-18 fluorodeoxyglucose positron emission tomography showed hot spots in these lymph nodes and in his right cervical lymph node, suggesting a lymphoma. The examination of an abdominal lymph node biopsy specimen showed lymph node tuberculosis, so antituberculosis treatment was started. However, after nine months of treatment, he experienced right flank pain. Abdominal computed tomography showed a right psoas abscess and abdominal para-aortic lymph node swelling. The abscess was treated by percutaneous drainage. After repeated drainage, the psoas abscess subsided and disappeared. The purulent fluid yielded no microorganisms, suggesting a paradoxical reaction.ConclusionAttention should be paid to paradoxical reactions occurring during antituberculosis treatment for systemic lymph node tuberculosis.
Highlights
A paradoxical reaction during antituberculosis treatment is defined as the worsening of pre-existing tuberculosis lesions or the appearance of a new tuberculosis lesion in patients whose clinical symptoms improved with antituberculosis treatment
Attention should be paid to paradoxical reactions occurring during antituberculosis treatment for systemic lymph node tuberculosis
We report the case of a patient with systemic lymph node TB presenting with the paradoxical reaction of an aseptic psoas abscess that appeared after approximately nine months of anti-TB treatment
Summary
A paradoxical reaction during antituberculosis (TB) treatment is described as a relatively rare manifestation and defined as the clinical or radiological worsening of pre-existing TB lesions or the development of new lesions in a patient who initially improves [1,2,3]. We report the case of a patient with systemic lymph node TB presenting with the paradoxical reaction of an aseptic psoas abscess that appeared after approximately nine months of anti-TB treatment. An abdominal CT revealed a large lowattenuation mass in his right psoas muscle and an enlarged para-aortic lymph node adjacent to the muscle (Figure 3). The level of adenosine deaminase in the fluid was elevated to 245IU/L After drainage, his right flank pain improved. The psoas abscess subsided to 4.5cm×3.0cm×9.0cm and the lymph node to 1.5cm in diameter. Two months after the end of treatment, the disappearance of both the abscess and the lymph node swelling were confirmed by abdominal CT. No sign of relapse had been detected 15 months after the end of treatment
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