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A Case Report of Tuberculous Brain Abscess and Tuberculous Peritonitis Developing Due to Paradoxical Reactions
박민범 (서울적십자병원)
이기조 (서울적십자병원)
정은호 (서울적십자병원)
김진우 (서울적십자병원)
서상렬 (서울적십자병원)
강석우 (서울적십자병원)
김은나 (서울적십자병원)
한윤주 (서울적십자병원)
조삼권 (서울적십자병원)
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Abstract
While receiving appropriate treatment, patients with tuberculosis occasionally have unusual, paradoxical reactions, with transient worsening of lesions or the development of new lesions. This report is a case of tuberculosis brain abscess and tuberculosis peritonitis with intra-abdominal abscess that developed during appropriate anti-tuberculosis chemotherapy. A 45-year-old male patient had been diagnosed as with all-drug susceptible pulmonary tuberculosis with pleurisy. Subsequently, the patient underwent standard treatment with anti-tuberculosis therapy; the pulmonary lesions improved. Three months after initial treatment, the patient developed brain abscesses and peritonitis. With the addition of corticosteroid treatment, the patient’s neurologic symptoms were relieved. Exploratory laparotomy with surgical drainage was performed and a diagnosis of tuberculosis peritonitis was confirmed on biopsy. Anti-tuberculosis therapy was continued for 19 months, the patient improved eventually without further complications, although the therapeutic regimen had not been altered. In this case, the paradoxical response to treatment may have been involved in the pathogenesis of disease.
- keywords
- Paradoxical response, Tuberculosis brain abscess, Tuberculosis peritonitis
참고문헌
Cheng VC, Ho PL, Lee RA, Chan KS, Chan KK, Woo PC, et al. Clinical spectrum of paradoxical deterioration during antituberculosis therapy in non-HIV-infected patients. Eur J Clin Microbiol Infect Dis 2002;21:803-9.
Hung SC, Chang SC. New pulmonary lesions during therapy for extrapulmonary tuberculosis. Chest 1999;116:1794-7.
Onal IK, Bayraktar Y, Unal S. Paradoxical deterioration during the course of antituberculous treatment. J Natl Med Assoc 2006;98:954-5.
Al-Majed SA. Study of paradoxical response to chemotherapy in tuberculous pleural effusion. Respir Med 1996;90:211-4.
Campbell IA, Dyson AJ. Lymph node tuberculosis: a comparison of various methods of treatment. Tubercle 1977;58:171-9.
Kim SH, Chung HY, Lee GD, Shin MG, Jung TS, Jin BC, et al. Clinical characteristics of paradoxical response to chemotherapy in pulmonary tuberculosis. Tuberc Respir Dis 2002;53:27-35.
Narita M, Ashkin D, Hollender ES, Pitchenik AE. Paradoxical worsening of tuberculosis following antiretroviral therapy in patients with AIDS. Am J Respir Crit Care Med 1998;158:157-61.
Ha CY, Kim JY, Kim GC, Ryeom HK, Kim HJ, Lee HJ, et al. An intraperitoneal tuberculous abscess: computed tomography (CT) findings and clinical course. Korean J Med 2008;74:243-9.
Afghani B, Lieberman JM. Paradoxical enlargement or development of intracranial tuberculomas during therapy: case report and review. Clin Infect Dis 1994;19:1092-9.
Meintjes G, Rangaka MX, Maartens G, Rebe K, Morroni C, Pepper DJ, et al. Novel relationship between tuberculosis immune reconstitution inflammatory syndrome and antitubercular drug resistance. Clin Infect Dis 2009;48:667-76.
Marshall BG, Chambers MA. Central nervous system tuberculosis: the paradox of the host immune response. J Infect 1998;36:3-4.
Blumberg HM, Burman WJ, Chaisson RE, Daley CL, Etkind SC, Friedman LN, et al. American Thoracic Society/ Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med 2003;167:603–62.
Kim JY, Kwon JH, Kim MJ, Chang HW, Hwang JS, Cho KB, et al. Paradoxical response during antituberculous treatment for abdominal tuberculosis. J Korean Radiol Soc 2006;55:599-605.
de Castro CC, de Barros NG, Campos ZM, Cerri GG. CT scans of cranial tuberculosis. Radiol Clin North Am 1995;33:753-69.
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