Disseminated tuberculosis after pregnancy progressed to paradoxical response to the treatment: report of two cases.
Early postpartum women are more likely to develop tuberculosis than nonpregnant women mainly due to immune reconstitution after delivery. Paradoxical response (PR) during antituberculosis treatment also arises via recovery from immunosuppression. However, no study focused on PR during antituberculosis treatment in a postpartum patient has been reported.



We present two sequential cases (Patient 1: 26-year-old; Patient 2: 29-year-old) of postpartum tuberculosis with pulmonary and extrapulmonary lesions (Patient 1: peritonitis; Patient 2: psoas abscess secondary to spondylitis). Both cases progressed to PR (worsening of pre-existing lung infiltrations (Patients 1, 2) and new contralateral effusion (Patient 2)) in a relatively short time after initiation of treatment (Patient 1: 1 week; Patient 2: 3 weeks), suggesting that immune modulations during pregnancy and delivery may contribute to the pathogenesis of both disseminated tuberculosis and its PR. The pulmonary lesions and effusion of both cases gradually improved without change of chemotherapy regimen.



Physicians should recognize PR in tuberculosis patients with postpartum and then evaluate treatment efficacy.
Department of Clinical Investigation, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan. shinoharat@kochi2.hosp.go.jp.
Tsutomu
T
Shinohara
Division of Pulmonary Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan.
Kozo
K
Kagawa
Division of Pulmonary Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan.
Yoshio
Y
Okano
Division of Thoracic Surgery, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan.
Toru
T
Sawada
Division of Orthopaedic Surgery, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan.
Tooru
T
Kobayashi
Division of Obstetrics and Gynecology, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan.
Masaya
M
Takikawa
Division of Hematology, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan.
Yoshihito
Y
Iwahara
Division of Pulmonary Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan.
Fumitaka
F
Ogushi
D000208:Acute Disease; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D006801:Humans; D014395:Peritonitis, Tuberculous / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000276:immunology; D049590:Postpartum Period / Q000276:immunology; D011247:Pregnancy; D016659:Psoas Abscess / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology; D011645:Puerperal Infection / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000276:immunology; D013902:Radiography, Thoracic; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000276:immunology; D014399:Tuberculosis, Spinal / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000276:immunology
D000995:Antitubercular Agents
Paradoxical response; Pregnancy; Tuberculosis