Paradoxical responses in non-HIV-infected patients with peripheral lymph node tuberculosis.
OBJECTIVE
We evaluated the clinical characteristics and risk factors for the paradoxical response (PR) in non-HIV-infected patients with peripheral lymph node tuberculosis (TB).


METHODS
Medical records of non-HIV-infected patients aged > or =16 years with peripheral lymph node TB treated in a tertiary hospital between January 1997 and August 2007 were analysed. PR was defined as clinical or radiological worsening of pre-existing TB lesions, or development of new lesions in a patient who had received anti-TB therapy for at least 2 weeks.


RESULTS
Three hundred patients with lymph node TB were included. Of these, 235 patients (78%) had confirmed TB; the remaining 65 (22%) had probable TB and were excluded from the final analysis. Among the 235 study patients, their mean age (+/-standard deviation) was 37.6 (+/-13.9) years and 175 (75%) were female. PR occurred in 54 (23%; 95% confidence interval 18-28%) patients, at a median onset time of 8 weeks (interquartile range, 4-14 weeks) after starting anti-TB medication. In multivariate analysis, younger age (OR 0.96), male gender (OR 2.60), and the presence of local tenderness at the time of diagnosis (OR 2.90) were independently associated with PR.


CONCLUSIONS
PR was relatively common, occurring in one-fifth of non-HIV-infected patients with peripheral lymph node TB, and was associated with younger age, male gender, and the presence of local tenderness.
Cho
Oh-Hyun
OH
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul, Republic of Korea.
Park
Ki-Ho
KH
Kim
Tark
T
Song
Eun Hee
EH
Jang
Eun-Young
EY
Lee
Eun Jung
EJ
Chong
Yong Pil
YP
Choi
Sang-Ho
SH
Lee
Sang-Oh
SO
Woo
Jun Hee
JH
Kim
Yang Soo
YS
Kim
Sung-Han
SH
D000328:Adult; D000995:Antitubercular Agents / Q000009:adverse effects*; D005260:Female; D015658:HIV Infections; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D014388:Tuberculosis, Lymph Node / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D055815:Young Adult
D000995:Antitubercular Agents