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Respuesta paradójica de aparición tardía 11 años después del tratamiento de abscesos hepáticos tuberculosos en un
Kodai Suzue1, Yasuo Tanaka2, Naoki Akazawa1
1Department of Gastroenterology, National Center for Global Health and Medicine, Japan Institute for Health Security, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan.
Clinical journal of gastroenterology
|August 31, 2025
Resumen
Las respuestas paradójicas (PR) al tratamiento antituberculoso (anti-TB) pueden ocurrir tarde después de la finalización del tratamiento. Este caso raro pone de relieve la importancia de considerar las PR para evitar la administración innecesaria de fármacos antituberculosos.
Área de la Ciencia:
- Enfermedades infecciosas
- Hepatología
- Inmunología
Sus antecedentes:
- Las respuestas paradójicas al tratamiento antituberculoso (antituberculosis) implican el empeoramiento o nuevas lesiones a pesar de la mejoría inicial.
- Los PR son menos comunes en individuos VIH negativos y rara vez se presentan como abscesos hepáticos.
- Los PR de aparición tardía después de completar el tratamiento contra la tuberculosis son poco comunes y difíciles de diferenciar de la recaída.
Objetivo del estudio:
- Informar de un caso raro de respuesta paradójica de aparición tardía al tratamiento antituberculoso presentándose como abscesos hepáticos.
- Hacer hincapié en los desafíos de diagnóstico y las consideraciones de gestión para los PR posteriores al tratamiento.
- Destacar la importancia de considerar las RP en los diagnósticos diferenciales incluso años después del tratamiento de la tuberculosis.
Principales métodos:
- Informe de caso de una mujer VIH negativa de 51 años con antecedentes de tuberculosis tratada, incluyendo abscesos hepáticos.
- El diagnóstico incluyó tomografía computarizada, biopsia hepática guiada por ultrasonido, histopatología, reacción en cadena de polimerasa (PCR) y cultivos de TB.
- Observación clínica sin tratamiento antituberculoso adicional.
Principales resultados:
- El paciente presentó nuevos nódulos hepáticos 11 años después de completar el tratamiento antituberculoso.
- La biopsia hepática mostró granulomas con necrosis caseosa, pero la PCR y los cultivos para la tuberculosis fueron negativos.
- El paciente fue diagnosticado con PR de aparición tardía después del tratamiento y se observó que los abscesos hepáticos regresaron espontáneamente.
Conclusiones:
- Las respuestas paradójicas de aparición tardía pueden ocurrir mucho después de la finalización del tratamiento contra la tuberculosis.
- Distinguir las RP posteriores al tratamiento de la recaída de la tuberculosis es crucial para un tratamiento adecuado.
- Es importante evitar la administración innecesaria de fármacos antituberculosos en los casos sospechosos de PR.
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