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Clinical Course of Patients With Mediastinal Lymph Node Tuberculosis and Risk Factors for Paradoxical Responses
Junsu Choe1, Areum Han2, Sun Hye Shin1
1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Journal of Korean Medical Science
|December 5, 2023
Summary
Paradoxical responses (PR) affect 17% of patients with mediastinal lymph node tuberculosis (LNTB). Younger age, low lymphocyte count, and larger lymph nodes are key risk factors for developing PR during treatment.
Area of Science:
- Infectious Diseases
- Pulmonology
- Oncology
Background:
- Paradoxical responses (PR) are more common in lymph node tuberculosis (LNTB) than pulmonary tuberculosis.
- PR complicates the diagnosis of drug resistance, new infections, poor compliance, and adverse drug reactions.
- Endosonography has improved mediastinal LNTB diagnosis, but data on PR remain limited.
Purpose of the Study:
- To investigate the clinical course of mediastinal LNTB.
- To identify risk factors associated with PR in mediastinal LNTB patients.
Main Methods:
- Retrospective evaluation of patients diagnosed with mediastinal LNTB via endosonography (October 2009 - December 2019).
- Multivariable logistic regression analysis to determine risk factors for PR.
Main Results:
- 158 patients diagnosed with mediastinal LNTB out of 9,052 undergoing endosonography.
- 17% (21/125) of patients completing treatment developed PR.
- PR was independently associated with age < 55 years, lymphocyte count < 800/μL, and largest lymph node short axis diameter ≥ 16 mm.
Conclusions:
- PR occurs in approximately one in six patients with mediastinal LNTB.
- Physicians should consider younger age, lymphocytopenia, and larger lymph nodes as risk factors for PR at diagnosis.
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