Irish journal of medical science · 2026
Paradoxical reactions during treatment of miliary tuberculosis: a 25-year single-centre case series and literature review.
СтатьяОбзорНазвание и аннотация: Перевод пока не подготовлен
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Kaya Abdurrahman, Mert Ali
Аннотация
BACKGROUND: Paradoxical reactions during otherwise effective anti-tuberculosis treatment can resemble treatment failure or drug resistance. Their frequency and clinical spectrum in miliary tuberculosis are incompletely characterised.
AIMS: To describe the timing, manifestations, management and outcomes of paradoxical reactions identified in a defined cohort of patients with miliary tuberculosis and to place these events in the context of the published literature.
METHODS: We retrospectively reviewed the records of 63 patients with miliary tuberculosis managed at a single centre between 1981 and 2005. A paradoxical reaction was defined as clinical or radiological worsening of an initially improving lesion, or development of a new lesion during appropriate therapy, after reasonable exclusion of treatment failure, drug resistance and alternative diagnoses.
RESULTS: Five of 63 patients (7.9%) developed six paradoxical reaction episodes. Manifestations included multiple subcutaneous abscesses, two small-intestinal perforations, two spontaneous pneumothoraces and progression of miliary nodules with new cavitary lesions. Reactions occurred 10-240 days after treatment initiation (median, 108 days). Five episodes required surgical or interventional management. The anti-tuberculosis regimen was continued without modification in every episode. One patient developed two reactions despite corticosteroid treatment for systemic lupus erythematosus. All patients recovered, with no recurrence during 4-24 months of follow-up.
CONCLUSIONS: Paradoxical reactions in miliary tuberculosis may be anatomically diverse and life-threatening. Recognition of this pattern, together with careful exclusion of microbiological failure, can prevent unnecessary alteration of effective treatment while ensuring timely management of site-specific complications.
AIMS: To describe the timing, manifestations, management and outcomes of paradoxical reactions identified in a defined cohort of patients with miliary tuberculosis and to place these events in the context of the published literature.
METHODS: We retrospectively reviewed the records of 63 patients with miliary tuberculosis managed at a single centre between 1981 and 2005. A paradoxical reaction was defined as clinical or radiological worsening of an initially improving lesion, or development of a new lesion during appropriate therapy, after reasonable exclusion of treatment failure, drug resistance and alternative diagnoses.
RESULTS: Five of 63 patients (7.9%) developed six paradoxical reaction episodes. Manifestations included multiple subcutaneous abscesses, two small-intestinal perforations, two spontaneous pneumothoraces and progression of miliary nodules with new cavitary lesions. Reactions occurred 10-240 days after treatment initiation (median, 108 days). Five episodes required surgical or interventional management. The anti-tuberculosis regimen was continued without modification in every episode. One patient developed two reactions despite corticosteroid treatment for systemic lupus erythematosus. All patients recovered, with no recurrence during 4-24 months of follow-up.
CONCLUSIONS: Paradoxical reactions in miliary tuberculosis may be anatomically diverse and life-threatening. Recognition of this pattern, together with careful exclusion of microbiological failure, can prevent unnecessary alteration of effective treatment while ensuring timely management of site-specific complications.