Paradoxical reaction of tuberculous vertebral osteomyelitis: a case series

Paradoxical reactions of tuberculosis (TB) in vertebral osteomyelitis are very rarely reported. We experienced four cases of severe paradoxical reactions in tuberculous vertebral osteomyelitis. Four cases of tuberculous vertebral osteomyelitis were confirmed by an acid-fast bacilli smear or culture. The patients were human immunodeficiency virus negative, and were all initially treated with isoniazid, ethambutol, rifampicin and pyrazinamide. Their symptoms improved with anti-TB drugs. However, after 2-12 weeks, their symptoms had recurred, and spinal magnetic resonance imaging at the time of readmission revealed an aggravation of vertebral osteomyelitis. Operations were carried out to relieve severe pain or spinal cord decompression. Through continued anti-TB drug therapy, all patients recovered without sequelae.