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Song, Baek, Jung, Lee, Lee, Lee, Lee, Lee, Lee, and Kim: Paradoxical Response Developed during the Antituberculous Treatment in Tuberculous Pleurisy
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2008; 64(6): 427-432.

Published online: 30 June 2008

DOI: https://doi.org/10.4046/trd.2008.64.6.427

Paradoxical Response Developed during the Antituberculous Treatment in Tuberculous Pleurisy

Eun Ju Song, M.D., Dae Hyun Baek, M.D., Jun Young Jung, M.D., Sang Ryul Lee, M.D., Myong Ha Lee, M.D., Sung Hyuk Lee, M.D., Jae Hyung Lee, M.D., Ki Deok Lee, M.D., Byoung Hoon Lee, M.D., Sang Hoon Kim, M.D.

Department of Internal Medicine, Eulji Hospital, College of Medicine, Eulji University, Seoul, Korea.

Address for correspondence: Byoung Hoon Lee, M.D. Department of Internal Medicine, Eulji Hospital, College of Medicine, Eulji University, 280-1, Hagye-dong, Nowon-gu, Seoul 139-872, Korea. Phone: 82-2-970-8625, Fax: 82-2-970-8621, hoonakr@eulji.ac.kr

Received 29 April 2008       Accepted 2 June 2008

Copyright © 2008 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Background

A paradoxical response is defined as the radiological and clinical worsening of a previous lesion or the development of new lesion after initial improvement during theprocess of antituberculous treatment. The related factors for the development of a paradoxical response in patients with tuberculous pleurisy are not certain.

Methods

We selected patients with tuberculous pleurisy who had been treated for more than 4 months. The changes onthe serial chest X-ray findings before and after treatment were reviewed. Paradoxical responses were regarded as any worsening or development of new lesion at least 2 weeks after the initiation of treatment. The baseline clinical characteristics and laboratory findings of the peripheral blood and pleural fluid were compared between the patients with a paradoxical response and the patients without a paradoxical response.

Results

Paradoxical responses appeared in sixteen patients (21%) among the 77 patients.It took a mean of 38.6 days after the treatment and the time to resolve the paradoxical response was a mean of 32.1 days. For the patients with a paradoxical response, the median age was younger (30.5 years vs 39.0 years, respectively) and the lymphocytic percentage of white blood cells in the pleural fluid was higher (82.1% vs 69.6%, respectively) than for the patients without a paradoxical response.

Conclusion

The development of a paradoxical response during the treatment of patients with tuberculous pleurisy was not rare and this was related with the age of the patients and the percentage of lymphocytic white blood cells in the pleural fluid.

Keywords: Tuberculous pleurisy, Paradoxical response, Antitubercular agents

Figures and Tables

Figure 1
Comparison of age (A) and lymphocytic percentage in pleural fluid (B) between patients with paradoxical response and without paradoxical response. Both comparisons showed significant difference (p<0.05). Horizontal bars mean median value (A) and mean value (B). PR: paradoxical response.
trd-64-427-g001
Table 1
Baseline characteristics of all patients (n=77)
trd-64-427-i001

LDH: lactate dehydrogenase; ADA: adenosine deaminase.

Data are mean±SD not otherwise specified.

Table 2
Comparison of characteristics between patients with paradoxical response and without paradoxical response
trd-64-427-i002

LDH: lactate dehydrogenase; ADA: adenosin deaminase; PF/S: pleural fluid/serum.

*patients with paradoxical response, †patients without paradoxical response. Data are mean±SD not otherwise specified.

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