Paradoxical reaction associated with cervical lymph node tuberculosis: predictive factors and therapeutic management.
OBJECTIVE
The aims of this study were to determine predictive factors of paradoxical reaction in patients with cervical lymph node tuberculosis (TB) and to discuss the therapeutic management of this condition.


METHODS
A retrospective study was performed of 501 patients managed for cervical lymph node TB over a period of 12 years (from January 2000 to December 2011). Statistical data were analyzed using IBM SPSS Statistics version 20.0.


RESULTS
Paradoxical reaction occurred in 67 patients (13.4%), with a median delay to onset after starting TB treatment of 7 months. Lymph node size ≥3cm and associated extra-lymph node TB were independently associated with paradoxical reaction. Treatment consisted of surgical excision (71.6%), restarting quadruple therapy (10.4%), reintroduction of ethambutol (23.8%), and addition of ciprofloxacin (20.8%); steroids were given in two cases . All patients recovered after an average treatment duration of 14.91±7.03 months.


CONCLUSIONS
The occurrence of paradoxical reaction in cervical lymph node TB seems to be predicted by associated extra-lymph node TB and a swelling size ≥3cm. The treatment of paradoxical reaction remains unclear and more randomized trials are necessary to improve its management.
Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia; Otorhinolaryngology Department, Rabta Hospital, Jebel Lakhdar Bab Saadoune, 1007 Tunis, Tunisia. Electronic address: houda.chahed@gmail.com.
Houda
H
Chahed
Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia; Otorhinolaryngology Department, Rabta Hospital, Jebel Lakhdar Bab Saadoune, 1007 Tunis, Tunisia.
Hela
H
Hachicha
Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia; Infectious Diseases Department, Rabta Hospital, Tunis, Tunisia.
Aida
A
Berriche
Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia; Infectious Diseases Department, Rabta Hospital, Tunis, Tunisia.
Rim
R
Abdelmalek
Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia; Otorhinolaryngology Department, Rabta Hospital, Jebel Lakhdar Bab Saadoune, 1007 Tunis, Tunisia.
Azza
A
Mediouni
Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia; Infectious Diseases Department, Rabta Hospital, Tunis, Tunisia.
Badreddine
B
Kilani
Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia; Otorhinolaryngology Department, Rabta Hospital, Jebel Lakhdar Bab Saadoune, 1007 Tunis, Tunisia.
Mohamed Ben
MB
Amor
Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia; Infectious Diseases Department, Rabta Hospital, Tunis, Tunisia.
Hanene Tiouiri
HT
Benaissa
Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia; Otorhinolaryngology Department, Rabta Hospital, Jebel Lakhdar Bab Saadoune, 1007 Tunis, Tunisia.
Ghazi
G
Besbes
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002939:Ciprofloxacin / Q000627:therapeutic use; D019468:Disease Management; D004977:Ethambutol / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000187:drug effects / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014388:Tuberculosis, Lymph Node / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D055815:Young Adult
D000900:Anti-Bacterial Agents; D000995:Antitubercular Agents; D002939:Ciprofloxacin; D004977:Ethambutol
Cervical lymph node; Paradoxical reaction; Treatment; Tuberculosis