S A Al-Majed1. 1. Department of Medicine, King Saud University, Saudi Arabia.
Abstract
BACKGROUND: Paradoxical worsening of disease, in spite of effective chemotherapy for tuberculosis, has been reported to occur in cases of intracranial tuberculoma, lymph node, and pulmonary tuberculosis. However, only rare case reports describe such paradoxical response in tuberculosis pleurisy. METHODS: Sixty-one patients with proven tuberculous pleural effusion were retrospectively screened in Riyadh, Saudi Arabia, in three major hospitals to look systematically at the incidence and features of paradoxical response. RESULTS: Paradoxical increase in the size of the effusion was detected in 10 of 61 patients. In six patients, the effusion became massive with worsening of dyspnoea requiring the use of corticosteroids in five patients and therapeutic aspiration in all six. However, complete resolution occurred in all 10 patients within 1-3 months. Three out of the 10 patients developed residual pleural thickening. CONCLUSION: An incidence of 16% (10/61) paradoxical worsening of tuberculous effusion following the start of anti-tuberculous treatment has been documented. This resulted in respiratory distress necessitating therapeutic re-aspiration in six of 10 patients.
BACKGROUND: Paradoxical worsening of disease, in spite of effective chemotherapy for tuberculosis, has been reported to occur in cases of intracranial tuberculoma, lymph node, and pulmonary tuberculosis. However, only rare case reports describe such paradoxical response in tuberculosis pleurisy. METHODS: Sixty-one patients with proven tuberculous pleural effusion were retrospectively screened in Riyadh, Saudi Arabia, in three major hospitals to look systematically at the incidence and features of paradoxical response. RESULTS: Paradoxical increase in the size of the effusion was detected in 10 of 61 patients. In six patients, the effusion became massive with worsening of dyspnoea requiring the use of corticosteroids in five patients and therapeutic aspiration in all six. However, complete resolution occurred in all 10 patients within 1-3 months. Three out of the 10 patients developed residual pleural thickening. CONCLUSION: An incidence of 16% (10/61) paradoxical worsening of tuberculous effusion following the start of anti-tuberculous treatment has been documented. This resulted in respiratory distress necessitating therapeutic re-aspiration in six of 10 patients.
Authors: V C C Cheng; W C Yam; P C Y Woo; S K P Lau; I F N Hung; S P Y Wong; W C Cheung; K Y Yuen Journal: Eur J Clin Microbiol Infect Dis Date: 2003-09-24 Impact factor: 3.267
Authors: Hye Seon Kang; Hwa Young Lee; Jung Im Jung; Ju Sang Kim; Yong Hyun Kim; Seung Joon Kim; Seok Chan Kim; Soon Seog Kwon; Young Kyoon Kim; Ji Young Kang Journal: J Thorac Dis Date: 2018-11 Impact factor: 2.895