PURPOSE: Paradoxical response (PR) in tuberculous disease during antituberculous treatment is defined as a development of radiological or clinical worsening of preexisting lesion after initial improvement. Risk factors for the development of PR in tuberculous pleurisy are not certain.
METHODS: 77 patients with tuberculous pleurisy who had taken antituberculous medication for at least 4 months were selected. Serial chest X-rays and results of laboratory tests during treatment were reviewed retrospectively. Any worsening or a development of new lesion after 2 weeks from initiation of antituberculous treatment were regarded as PR. Clinical characteristics and laboratory findings of patients with PR were compared with those of patients without PR during treatment.
RESULTS: PR were developed in 16 patients (16/77, 21%); 14 patients with the aggravation of preexisting pleural effusion and 2 patients with development of new lung parenchymal lesion. Mean duration from antituberculous treatment to the development of PR were 38.6±21.0 days. Patients with PR were younger than patients without PR (30.7±8.9 years vs. 43.9±19.6 years, p=0.016). In patients with PR, lymphocytic percentage of white blood cells in pleural fluid was higher (82.1±16.9% vs. 68.2±25.4%, p=0.021) and symptom duration before antituberculous treatment was shorter (15.7±15.3 days vs. 27.1±23.6 days, p=0.045) than in patients without PR.
CONCLUSION: Paradoxical responses in patients with tuberculous pleurisy occurred in 21% during antituberculous chemotherapy. The developments of PR were more frequent in patients with younger age, initial higher differential count of pleural fluid lymphocytes and shorter symptom duration before antituberculous treatment.
CLINICAL IMPLICATIONS: In the face of development of radiological worsening of preexisting lesion of tuberculous pleurisy after initial improvement the occurence of paradoxical response must be considered, espacially in patients with younger age (less than 50 years) or higher lymphocyte differential count in pleural fluid (more than 50%).
DISCLOSURE: Byoung hoon Lee, No Financial Disclosure Information; No Product/Research Disclosure Information