Hepatic abscess as a paradoxical response to antituberculous chemotherapy for tubercular lymphadenitis

Tubercular liver abscess developing as a paradoxical reaction (PR) to antitubercular therapy (ATT) is relatively uncommon in the absence of disseminated disease and immunocompromised status of the host even in countries such as India where the disease is rampant. We report a rare case of hepatic abscess that developed paradoxically during antituberculous therapy for tubercular lymphadenitis in a 30-year-old woman who tested negative for HIV. Diagnosis was performed with the help of ultrasonography (USG)-guided aspiration of the abscess followed by cytopathological examination and PCR confirmation of the disease from the USG-guided aspirate. The patient responded well to oral corticosteroid therapy without any alteration of the ongoing ATT regimen. Details of the case and other relevant literature regarding the pathogenesis of this event are discussed in detail.