Infection and Drug Resistance (Nov 2019)
Paradoxical Reaction In The Form Of New Pulmonary Mass During Anti-Tuberculosis Treatment: A Case Series And Literature Review
Abstract
Ting Guo,1–3 Wei Guo,1–3 Min Song,1–3 Shanshan Ni,1–3 Man Luo,1–3 Ping Chen,1–3 Hong Peng1–3 1Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital of Central-South University, Changsha, Hunan 410011, People’s Republic of China; 2Research Unit of Respiratory Disease, Central-South University, Changsha, Hunan 410011, People’s Republic of China; 3The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, Hunan 410011, People’s Republic of ChinaCorrespondence: Hong PengDepartment of Respiratory and Critical Care Medicine, The Second Xiangya Hospital Of Central-South University, No. 139 Renmin Middle Road, Changsha, Hunan 410011, People’s Republic of ChinaTel +86-13807494486Fax +86 731-85295147Email [email protected]: Paradoxical reaction refers to deterioration of the original tuberculosis lesions or emergence of new infiltrative lesions during anti-tuberculosis treatment. The common manifestations of paradoxical reaction include new pleural effusion, cerebral tuberculosis and lymphadenitis. Paradoxical reaction manifested by new pulmonary mass is rare.Patients and methods: This article summarizes and analyzes the clinical manifestations, chest CT, laboratory findings, treatments, pathological biopsy results of five patients diagnosed as paradoxical reaction in the form of new pulmonary mass. A literature review related to paradoxical reaction was conducted.Results: Five patients diagnosed as pulmonary tuberculosis or tuberculous pleuritis received systematic anti-tuberculosis treatmensssts. New pulmonary masses were found by CT scans during the follow-ups. The patients were negative for tumor markers, examination of rheumatoid connective tissue disease and G/GM test. The original anti-tuberculosis treatments were continued. All of the masses were diminished gradually.Conclusion: Paradoxical reaction needs to be taken into consideration when a new pulmonary mass occurs during anti-tuberculosis treatments. The diagnosis should be based on the patients’ clinical manifestations, laboratory results, imaging examinsssations and lung biopsy examinations. The original anti-tuberculosis therapy can be continued in patients without severe clinical symptoms. A close follow-up is needed.Keywords: tuberculosis, paradoxical reaction, mass
