Clinical Worsening in an Adolescent With Pleural Tuberculosis.

Autor: Cruz AT; Department of Pediatrics, Baylor College of Medicine, Houston, Texas. Electronic address: acruz@bcm.edu., Starke JR; Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
Jazyk: angličtina
Zdroj: The Journal of adolescent health : official publication of the Society for Adolescent Medicine [J Adolesc Health] 2023 Mar; Vol. 72 (3), pp. 480-482. Date of Electronic Publication: 2022 Dec 23.
DOI: 10.1016/j.jadohealth.2022.11.013
Abstrakt: A 17-year-old previously healthy female presented with unilateral chest pain and dyspnea. Chest radiographs demonstrated a unilateral pleural effusion and pneumonia. Pleural fluid bacterial cultures were negative; acid-fast cultures grew Mycobacterium tuberculosis. Two months after starting appropriate therapy, she had a recrudescence of symptoms and reaccumulation of the pleural fluid. Her tuberculosis antibiotic regimen was expanded, the effusion drained, and systemic corticosteroids initiated, resulting in rapid clinical improvement. Cultures of the second pleural fluid collection were negative. Her clinical deterioration was due to immune reconstitution inflammatory syndrome (IRIS). IRIS can be seen within the first several months of starting tuberculosis therapy and can result in paradoxical worsening of symptoms or radiographic findings in adolescents who are on the appropriate therapy. IRIS is a diagnosis of exclusion after drug resistance and medication malabsorption, intolerance, and nonadherence are excluded. Therapy includes nonsteroidal anti-inflammatory agents for milder reactions and systemic corticosteroids for more severe IRIS cases.
(Copyright © 2022 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: