Tuberculous adenitis: Difference between revisions
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===Paradoxical Reactions=== |
===Paradoxical Reactions=== |
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*Paradoxical reactions including paradoxical upgrading reaction are fairly common, occuring in about a quarter of cases[[CiteRef::hawkey2005ch]] |
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*Presents with enlarging lymphadenopathy during or sometimes after treatment |
*Presents with enlarging lymphadenopathy during or sometimes after treatment |
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*Occurs in 25% of adenitis |
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*Likely represents a reaction to an antigenic stimulus in poorly-cleared disease |
*Likely represents a reaction to an antigenic stimulus in poorly-cleared disease |
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*In post-treatment paradoxical reactions, need to differentiate from relapse |
*In post-treatment paradoxical reactions, need to differentiate from relapse |
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*90% resolve spontaneously |
*90% resolve spontaneously |
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*Steroids used commonly |
*Steroids used commonly |
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=== Relapse === |
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* About 2-3% of patients will have a relapse within 20 months[[CiteRef::van loenhout-rooyackers2000sh]] |
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[[Category:Tuberculosis]] |
[[Category:Tuberculosis]] |
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Revision as of 03:52, 19 September 2025
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 after 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 months2
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.
- ^ 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.
