title: An unusual case of paradoxical enlargement of lymph nodes during treatment of tuberculous lymphadenitis in immunocompetent patient and literature review.
abstract: METHODS
  Female, 21.
  
  
  METHODS
  Tuberculous lyphadenitis.
  
  
  METHODS
  Cough dry • fever • subcutaneous mass • weight loss.
  
  
  METHODS
  -
  
  
  METHODS
  -
  
  
  METHODS
  Pulmonology.
  
  
  OBJECTIVE
  Unusual clinical course.
  
  
  BACKGROUND
  Enlargement of lymph nodes during treatment of Tuberculous lymphadenitis is well recognized phenomenon in HIV infected patient with ample literature to help guide management. On the contrary, it poses a clinical challenge to distinguish between paradoxical reaction and treatment failure in HIV-seronegative patients and require high index of suspicion.
  
  
  METHODS
  We report a case of 21 year old female of Bangladeshi origin with tuberculous lymphadenitis diagnosed on the basis of strong clinical history and radiologic findings. Patient's clinical symptoms and lymphadenopathy initially improved but worsened after three months of RIPE therapy. This prompted re imaging and excision biopsy of enlarging lymph node to exclude other masqueraders. Patient was continued on same antituberculous treatment. Oral prednisone was added with subsequent clinical improvement and decrease in the size of lymphadenopathy.
  
  
  CONCLUSIONS
  Paradoxical reaction during anti tuberculous treatment must be considered after careful exclusion of medication non adherence, development of resistance and other similar conditions.
authors.affiliation: Department of Medicine, Pulmonary Critical Care, Mount Sinai Queens Hospital Center, Jamaica, NY, U.S.A.
authors.forename: Anil
authors.initials: A
authors.lastname: Singh
authors.forename: Habibur
authors.initials: H
authors.lastname: Rahman
authors.forename: Viki
authors.initials: V
authors.lastname: Kumar
authors.forename: Fnu
authors.initials: F
authors.lastname: Anila
keywords: Kikuchi’s disease (KD); highly active anti-retroviral therapy (HAART); isoniazid; paradoxical reaction (PR); pyrazinamide and ethambutol (RIPE); rifampin; tuberculosis (TB); tuberculosis lymphadenitis (TL)