Vertebral tuberculosis as a paradoxical reaction to the treatment of pulmonary and meningeal tuberculosis in an immunocompetent patient: A case report.

Autor:	Volpe-Chaves CE; Graduate Program in Infectious and Parasitic Diseases of Federal University of Mato Grosso do Sul.; Regional Hospital of Mato Grosso do Sul.; Maria Aparecida Pedrossian University Hospital., Lacerda MLGG; Regional Hospital of Mato Grosso do Sul., Castilho SB; Regional Hospital of Mato Grosso do Sul., Fonseca SSO; Regional Hospital of Mato Grosso do Sul., Saad BAA; Graduate Program in Infectious and Parasitic Diseases of Federal University of Mato Grosso do Sul.; Regional Hospital of Mato Grosso do Sul., Franciscato C; Graduate Program in Infectious and Parasitic Diseases of Federal University of Mato Grosso do Sul.; Maria Aparecida Pedrossian University Hospital., Tibana TK; Maria Aparecida Pedrossian University Hospital., Nunes TF; Maria Aparecida Pedrossian University Hospital., Venturini J; School of Medicine at Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil., Oliveira SMDVL; School of Medicine at Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil., Paniago AMM; School of Medicine at Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil.
Jazyk:	angličtina
Zdroj:	Medicine [Medicine (Baltimore)] 2020 May 22; Vol. 99 (21), pp. e20012.
DOI:	10.1097/MD.0000000000020012
Abstrakt:	Introduction: Paradoxical reaction in tuberculosis (TB) is defined as the reappearance of general symptoms, aggravation of pre-existing diseases, or appearance of new lesions despite adequate anti-TB therapy. It may result from the hyperactivity of the immune response, resulting in an intense inflammation. There are few cases of vertebral TB reported as paradoxical reaction, mainly among immunocompetents patients. Patient Concerns: We describe a male immunocompetent patient with confirmed pulmonary and meningeal TB. He was readmitted after 60 days of adequate treatment, with vertebral TB and paravertebral abscess, despite clinical improvement of the other locations. We defined as an uncommon case of a paradoxical reaction, confirmed by nuclear magnetic resonance and molecular rapid test for TB. Diagnosis: Mycobacterium tuberculosis (MTB) was detected in cerebrospinal fluid by molecular rapid test (Gene Xpert MTB/ rifampicina method). Sputum research and culture were positive for the same agent. Lumbosacral spine nuclear magnetic resonance revealed bone destruction from T8 to T11, and a paravertebral collection was found. Gene Xpert MTB/rifampicina and culture were positive for M tuberculosis in the drained material of the paravertebral abscess. Interventions: The paravertebral abscess was drainage by tomography-guided. Treatment with 4 anti-TB drugs was extended for 60 days and 2 anti-TB drugs was maintained for 10 months. There was a complete clinical improvement. Outcome: After draining the paravertebral abscess, the patient progressively improved and was discharged for outpatient follow-up. He was on antituberculous drugs for 1 year; subsequently, complete resolution of the infection was reported. Conclusion: Paradoxical reaction may be a difficult diagnosis in immunocompetent patient. Vertebral TB as a paradoxical reaction is an uncommon presentation. Therapeutic failure or resistance to treatment should be ruled out to confirm the diagnosis of paradoxical reaction.
Databáze:	MEDLINE
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