title: Paradoxical responses in non-HIV-infected patients with peripheral lymph node tuberculosis.
abstract: 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.
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul, Republic of Korea.
authors.forename: Oh-Hyun
authors.initials: OH
authors.lastname: Cho
authors.forename: Ki-Ho
authors.initials: KH
authors.lastname: Park
authors.forename: Tark
authors.initials: T
authors.lastname: Kim
authors.forename: Eun Hee
authors.initials: EH
authors.lastname: Song
authors.forename: Eun-Young
authors.initials: EY
authors.lastname: Jang
authors.forename: Eun Jung
authors.initials: EJ
authors.lastname: Lee
authors.forename: Yong Pil
authors.initials: YP
authors.lastname: Chong
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Sang-Oh
authors.initials: SO
authors.lastname: Lee
authors.forename: Jun Hee
authors.initials: JH
authors.lastname: Woo
authors.forename: Yang Soo
authors.initials: YS
authors.lastname: Kim
authors.forename: Sung-Han
authors.initials: SH
authors.lastname: Kim
mesh_terms: 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
chemical_list: D000995:Antitubercular Agents