title: Late paradoxical lymph node enlargement during and after anti-tuberculosis treatment in non-HIV-infected patients.
abstract: METHODS
  A tertiary referral centre in South Korea.
  
  
  OBJECTIVE
  To investigate the incidence, clinical characteristics and outcomes of late paradoxical response (>4 months after the initiation of anti-tuberculosis treatment) during and after anti-tuberculosis treatment in non-human immunodeficiency virus (HIV) infected patients with lymph node tuberculosis (TB).
  
  
  METHODS
  We retrospectively reviewed the medical records of non-HIV-infected patients with lymph node TB between 1997 and 2007, and prospectively enrolled patients with newly diagnosed lymph node TB between 2008 and 2013.
  
  
  RESULTS
  Of 467 patients with confirmed and probable lymph node TB, 83 (18%) displayed a paradoxical response: 57 of these (69%) were classified as early and 26 (31%) as late paradoxical response. Patients with late paradoxical response (median 12 months) received more prolonged anti-tuberculosis treatment than those with early (median 9 months, P < 0.001) or no paradoxical response (median 9 months, P < 0.001). The frequency of post-treatment lymph node enlargement increased progressively from those without any paradoxical response (6%), through those with an early response (12%) to those with a late response (23%).
  
  
  CONCLUSIONS
  Paradoxical response presents late in about one third of non-HIV-infected patients with lymph node TB who experience a response. Although anti-tuberculosis treatment is commonly prolonged in patients with late paradoxical response, post-treatment lymph node enlargement is more frequent in these patients.
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Division of Infectious Disease, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea.
authors.forename: S N
authors.initials: SN
authors.lastname: Yu
authors.affiliation: Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.
authors.forename: O-H
authors.initials: OH
authors.lastname: Cho
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
authors.forename: K-H
authors.initials: KH
authors.lastname: Park
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: J
authors.initials: J
authors.lastname: Jung
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Y K
authors.initials: YK
authors.lastname: Kim
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: J Y
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Y-P
authors.initials: YP
authors.lastname: Chong
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: S-O
authors.initials: SO
authors.lastname: Lee
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: S-H
authors.initials: SH
authors.lastname: Choi
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Y S
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Woo
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: S-H
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D005260:Female; D018023:HIV Seronegativity; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D056910:Republic of Korea; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D017211:Treatment Failure; D014388:Tuberculosis, Lymph Node / Q000188:drug therapy*
chemical_list: D000995:Antitubercular Agents