title: Paralysis developing as a paradoxical response during the treatment for tuberculous spondylitis: a case report.
abstract: It can be difficult for clinicians to distinguish a paradoxical response to antituberculous therapy, worsening of an existing lesion despite adequate treatment, treatment failure, and drug resistance. We report a case of a 69-year-old woman who experienced bilateral lower extremity paralysis secondary to a paradoxical response. She had been suffering for 1 month from low back pain, due to tuberculous spondylitis. Her low back pain improved after antituberculous therapy. The low back pain, however, reappeared 2 months after treatment, accompanied by newly developed lower extremity weakness. Imaging studies showed an increased extent of her previous lesions. Consequently, the patient underwent a vertebral corpectomy with interbody fusion of the thoracolumbar spine. Histopathological examination showed chronic inflamed granulation tissue with no microorganisms. Although the antituberculous medication was not changed, the patient's symptoms and signs, including the paralysis, resolved after surgery.
authors.affiliation: Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jae Hyeon
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Yeo Hyung
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Chan Hyuk
authors.initials: CH
authors.lastname: Kwon
authors.affiliation: Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Hyung-Ik
authors.initials: HI
authors.lastname: Shin
keywords: Paradoxical response; Paralysis; Spinal tuberculosis