Paradoxical response to anti-tuberculous drugs: resolution with corticosteroid therapy

During the course of appropriate treatment, patients with tuberculosis occasionally have unusual paradoxical reactions, with transient worsening of lesions or the development of new lesions. A 23-y-old housewife presented with abdominal tuberculosis. She was treated with anti-tuberculous agents to which the micro-organisms were susceptible. During therapy, there was an expansion of her abdominal lesions and her symptoms worsened. However, with the addition of steroids and the continuation of the same anti-tuberculous agents the patient eventually recovered completely. We emphasize that the worsening of tuberculous lesions may occur during chemotherapy and does not necessarily indicate treatment failure. This phenomenon may be immunologically based.