[Paradoxical radiologic progression despite appropriate anti-tuberculous therapy]

Area of Science:

• Pulmonology
• Infectious Diseases
• Medical Case Reports

Background:

• Paradoxical response, defined as clinical or radiological deterioration during appropriate anti-tuberculosis therapy, presents diagnostic challenges.
• This phenomenon holds both medical and legal significance due to difficulties in identification.
• Tuberculosis remains a prevalent public health concern, necessitating a thorough understanding of treatment responses.

Observation:

• A 68-year-old, Human Immunodeficiency Virus (HIV)-negative male presented with symptoms of active pulmonary tuberculosis.
• Initial chest CT revealed lung opacities; diagnosis was confirmed by acid-fast bacilli in sputum.
• Despite a standard four-drug regimen, the patient experienced initial radiological deterioration at one month.

Findings:

• No evidence of endobronchial lesions or persistent infection was found via bronchoscopy and lavage.
• The anti-tuberculosis therapy regimen remained unchanged.
• Gradual radiological regression of pulmonary infiltrates was observed, indicating a paradoxical response.

Implications:

• Temporary radiological worsening can occur in pulmonary tuberculosis patients undergoing appropriate anti-tuberculosis therapy.
• Microbiological monitoring is the gold standard for assessing treatment efficacy, surpassing radiological assessment.
• Differential diagnosis must consider comorbid conditions, drug reactions, patient compliance, and treatment failure.