Paradoxical reactions induced by antituberculous drugs in non-HIV infected patients: a cases series of four patients and literature review

The features of paradoxical reactions (PR) that occurred in non-HIV infected patients treated with antituberculous drugs are diverse. We report four new cases of such PR and review the literature. Were included all consecutive patients with PR that occurred in non-HIV infected patients who were trea...

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Bibliographic Details
Published in:La revue de medecine interne 2013-04, Vol.34 (4), p.202-208
Main Authors: Rakotoarivelo, R A, Vandenhende, M-A, Michaux, C, Morlat, P, Bonnet, F
Format: Article
Language:fre
Subjects:
Adult
Antitubercular Agents - adverse effects
Female
Glucocorticoids - therapeutic use
Humans
Hypercalcemia - chemically induced
Lymphadenitis - chemically induced
Lymphopenia - chemically induced
Male
Pericardial Effusion - chemically induced
Retrospective Studies
Spondylitis - chemically induced
Thoracic Vertebrae
Tuberculoma, Intracranial - chemically induced
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Summary:The features of paradoxical reactions (PR) that occurred in non-HIV infected patients treated with antituberculous drugs are diverse. We report four new cases of such PR and review the literature. Were included all consecutive patients with PR that occurred in non-HIV infected patients who were treated for tuberculosis and followed-up in the department of internal medicine and infectious diseases between January 1st, 2009 and July 31st, 2010. Three of the patients were male. Their median age was 28.5 years. Tuberculous locations were pulmonary (two instances) and extrapulmonary (three instances). Paradoxical reactions occurred after a median of 5.5 weeks after initiation of antituberculous treatment. The PR presented as hypercalcemia (n=1), spondylitis of the 9th thoracic vertebra (n=1), intracerebral tuberculoma (n=1), pericardial effusion (n=1) and adenitis (n=3). Lymphopenia was present in three patients. Three out of the four patients received corticosteroid. Outcome was favorable in three patients. Pardoxical reactions are more common in patients who present with extrapulmonary tuberculosis. Intracerebral tuberculomas and spondylitis may be asymptomatic. Prescription of corticosteroids remains controversial except for intracerebral tuberculoma.
ISSN:1768-3122
DOI:10.1016/j.revmed.2012.08.014