Tuberculous adenitis
From IDWiki
Clinical Manifestations
Paradoxical Reactions
- Paradoxical reactions including paradoxical upgrading reaction are fairly common, occuring in about a quarter of cases1
- Presents with enlarging lymphadenopathy during (or sometimes after2) treatment
- Likely represents a reaction to an antigenic stimulus in poorly-cleared disease
- In post-treatment paradoxical reactions, need to differentiate from relapse
- About half will be PCR positive, 20% will be AFB positive, but none are culture positive
- 90% resolve spontaneously
- Steroids used commonly
Relapse
- About 2-3% of patients will have a relapse within 20 months3
References
- ^ C. R. Hawkey, T. Yap, J. Pereira, D. A. J. Moore, R. N. Davidson, G. Pasvol, O. M. Kon, R. A. Wall, R. J. Wilkinson. Characterization and Management of Paradoxical Upgrading Reactions in HIV-Uninfected Patients with Lymph Node Tuberculosis. Clinical Infectious Diseases. 2005;40(9):1368-1371. doi:10.1086/429317.
- ^ Sabine M. Hermans, Onno W. Akkerman, Graeme Meintjes, Martin P. Grobusch. Post-tuberculosis treatment paradoxical reactions. Infection. 2024;52(5):2083-2095. doi:10.1007/s15010-024-02310-0.
- ^ JH van Loenhout-Rooyackers, RJ Laheij, C Richter, AL Verbeek. Shortening the duration of treatment for cervical tuberculous lymphadenitis. European Respiratory Journal. 2000;15(1):192-195. doi:10.1183/09031936.00.15119200.
