Paradoxical reaction to antituberculosis therapy after 6 months of treatment for pulmonary tuberculosis: A case report.
Paradoxical reactions (PRs) to antituberculosis (anti-TB) drugs during treatment are well known phenomena, but a PR presenting as a new pulmonary lesion after completion of treatment is extremely rare, and little is known about the management of such cases. A 44-year-old man was diagnosed with pulmonary TB. His sputum cultures became negative 45 days after the initiation of standard anti-TB treatment. Upon the patient's completion of 6 months of anti-TB therapy, computed tomography revealed a new irregularly shaped mass in the lower left pulmonary lobe. A transbronchial lung biopsy (TBLB) revealed caseous necrosis and granulomatosis surrounded by epithelioid and multinucleated giant cells. Cultures of both the TBLB specimen and bronchoalveolar lavage fluid remained negative for TB. The CT shadow disappeared 6 months later without further administration of anti-TB drugs. Careful observation without therapy may be sufficient for a patient treated for TB who develops a PR upon completion of treatment, if the patient has achieved a bacteriological remission.
Department of Respiratory Medicine, Cellular Transplantation Biology, Graduate School of Medicine, Kanazawa University, Japan; Department of Respiratory Medicine, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan. Electronic address: akihitookazaki1017@gmail.com.
Akihito
A
Okazaki
Department of Respiratory Medicine, Cellular Transplantation Biology, Graduate School of Medicine, Kanazawa University, Japan.
Satoshi
S
Watanabe
Department of Respiratory Medicine, Cellular Transplantation Biology, Graduate School of Medicine, Kanazawa University, Japan.
Taro
T
Yoneda
Department of Respiratory Medicine, Cellular Transplantation Biology, Graduate School of Medicine, Kanazawa University, Japan.
Johsuke
J
Hara
Department of Respiratory Medicine, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan.
Masaru
M
Nishitsuji
Department of Respiratory Medicine, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan.
Koichi
K
Nishi
Department of Respiratory Medicine, Cellular Transplantation Biology, Graduate School of Medicine, Kanazawa University, Japan.
Kazuo
K
Kasahara
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001706:Biopsy / Q000379:methods; D006801:Humans; D008168:Lung / Q000187:drug effects / Q000473:pathology; D008297:Male; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000473:pathology*
D000995:Antitubercular Agents
Completion of treatment; HIV-Negative; Immunocompetent; Paradoxical reaction; Pulmonary tuberculosis