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Updated: May 25, 2025

Analysis of 18FDG PET/CT Imaging as a Tool for Studying Mycobacterium tuberculosis Infection and Treatment in Non-human Primates
Published on: September 5, 2017
Paradoxical Reaction to Antituberculosis Therapy Mimicking Tumor Progression in Lung Cancer Patient
Eunkyoung Choi1, Yong-An Chung1, Ju Sang Kim2
1Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Abstract:
We describe the case of a 67-year-old man with lung cancer, who developed pulmonary tuberculosis (TB) following chemotherapy and subsequently exhibited a paradoxical reaction on positron emission tomography/computed tomography (PET/CT) after initiating antituberculosis therapy. While pulmonary consolidations improved with antituberculosis treatment, newly detected hypermetabolic mediastinal lymph nodes appeared on PET/CT. Based on the clinical course, we provisionally concluded that the mediastinal lymphadenopathy represented a paradoxical reaction. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) confirmed the diagnosis of TB. Clinicians added steroids and continued the antituberculosis medication, and follow-up PET/CT showed complete resolution of these lesions. This case highlights the importance of recognizing paradoxical reactions to antituberculosis therapy, when restaging PET/CT reveals divergent findings, with some tumor foci responding and other lesions appearing to be progressing.
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