title: Paradoxical reactions during treatment of tuberculosis with extrapulmonary manifestations in HIV-negative patients.
abstract: OBJECTIVE
  Tuberculous paradoxical reactions (PR) have been seldom studied in non-immunocompromised patients. We conducted a study to describe the incidence, clinical and biological features, treatment and outcome of PR in human immunodeficiency virus (HIV)-negative patients treated for extrapulmonary tuberculosis (TB) and to identify predictive factors of PR.
  
  
  METHODS
  A single-center retrospective study was conducted in consecutive HIV-negative patients presenting with TB with at least one extrapulmonary manifestation who were hospitalized in an internal medicine department between 2000 and 2010.
  
  
  RESULTS
  Seventy-six patients were enrolled in the study. Lymphadenitis was the most common extrapulmonary manifestation of tuberculosis among this patient population (72 %). PR occurred in 19 (25 %) patients, mostly involving the lymph nodes (68 %) and lung (16 %), but also the pericardium, pleura, bone, muscle and brain. Median time to PR onset after initiation of anti-TB regimen was 86 days (interquartile range 36-125). Treatment of PR consisted mainly of corticosteroids (47 % of patients) and needle aspiration of PR lymph nodes (31 %). Peripheral lymph node involvement (p = 0.009), lymphopenia (p = 0.03) and anemia (p = 0.002) at presentation were associated with PR occurrence. Outcome was favorable in all patients with PR but one; the latter suffered residual paraplegia.
  
  
  CONCLUSIONS
  Paradoxical reactions are frequent in the course of extrapulmonary TB treatment in HIV-negative patients but their outcome is excellent, except in some cases with central nervous system involvement.
authors.affiliation: Service de médecine interne, hôpital européen Georges Pompidou, Assistance publique-hôpitaux de Paris, 20 rue Leblanc, 75015, Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Geri
authors.forename: A
authors.initials: A
authors.lastname: Passeron
authors.forename: B
authors.initials: B
authors.lastname: Heym
authors.forename: J-B
authors.initials: JB
authors.lastname: Arlet
authors.forename: J
authors.initials: J
authors.lastname: Pouchot
authors.forename: L
authors.initials: L
authors.lastname: Capron
authors.forename: B
authors.initials: B
authors.lastname: Ranque
mesh_terms: D000328:Adult; D000740:Anemia / Q000382:microbiology / Q000473:pathology; D000995:Antitubercular Agents / Q000009:adverse effects*; D005260:Female; D018023:HIV Seronegativity; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology; D008199:Lymphadenitis / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000473:pathology; D010994:Pleura / Q000382:microbiology / Q000473:pathology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014388:Tuberculosis, Lymph Node / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology
chemical_list: D000995:Antitubercular Agents