Tuberc Respir Dis > Volume 53(1); 2002 > Article
Tuberculosis and Respiratory Diseases 2002;53(1):27-35.
DOI:    Published online July 1, 2002.
Clinical Characteristics of Paradoxical Response to Chemotherapy in Pulmonary Tuberculosis.
Soo Hee Kim, Hyo Young Chung, Ghie Dong Lee, Min Ghie Shin, Tae Sik Jung, Byung Cheol Jin, Hyun Jung Kim, Jin Jong You, Jong Deog Lee, Young Sil Hwang
1Department of International Medicine, Collage of Medicine, Gyeong Sang National University, Chinju, Korea.
2Department of Radiology, Collage of Medicine, Gyeong Sang National University, Chinju, Korea.
The paradoxical response refers to an enlargement of old lesions or unexpected new ones during apparently adequate antituberculous therapy. This response has been reported in cases of intracranial tuberculoma, tuberculous lymphadenopathy, tuberculous pleurisy and pulmonary tuberculosis. However, there are few reports on its frequency and clinical characteristics. METHOD: This study enrolled 205 patients who were treated with first line antituberculous agents for more than 6 months. We retrospectively studied 155 patients with pulmonary tuberculosis and 57 patients with pleural tuberculosis (7 patients had both) from July 1998 to March 2000. The patients were divided into the paradoxical response group and the non-paradoxical group. The clinical characteristics of the paradoxical group were investigated. Statistical analysis was done with an independent sample T-test and Chi-squared test. RESULT: 29 of the 205 patients(14.1%) had paradoxical response. Among the 29 patients, there were 19 pulmonary tuberculosis, 8 tuberculous pleurisy(2 patients had both). Paradoxical response appeared 32 days (mean 35 days in pulmonary tuberculosis, mean 25 days in tuberculous pleurisy) after the beginning of chemotherapy. The duration to regress less than half of initial chest lesion was 114 days in pulmonary tuberculosis and 124 days in tuberculous pleurisy, respectively. Most common clinical manifestation of paradoxical response patients was coughing in both pulmonary tuberculosis and tuberculous pleurisy. Male sex, high blood WBC count and high level of pleural fluid LDH were related with paradoxical response. CONCLUSION: These findings suggest that presponse usually appears 1 month and disappears within 4 months after the beginning of anti-tuberculous chemotherapy. Paradoxical response was relatively correlated with male sex, high blood WBC count and high level of pleural fluid LDH.
Key Words: Paradoxical response, Tuberculosis, Antituberculous therapy

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