دورية أكاديمية
أعرض في EDS

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

التفاصيل البيبلوغرافية
العنوان: Vertebral tuberculosis as a paradoxical reaction to the treatment of pulmonary and meningeal tuberculosis in an immunocompetent patient: A case report.
المؤلفون: 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.
المصدر: Medicine [Medicine (Baltimore)] 2020 May 22; Vol. 99 (21), pp. e20012.
نوع المنشور: Case Reports; Journal Article
اللغة: English
بيانات الدورية: Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 2985248R Publication Model: Print Cited Medium: Internet ISSN: 1536-5964 (Electronic) Linking ISSN: 00257974 NLM ISO Abbreviation: Medicine (Baltimore) Subsets: MEDLINE
أسماء مطبوعة: Original Publication: Hagerstown, Md : Lippincott Williams & Wilkins
مواضيع طبية MeSH: Antitubercular Agents/*adverse effects , Immunocompetence/*drug effects , Tuberculosis, Meningeal/*drug therapy , Tuberculosis, Pulmonary/*drug therapy , Tuberculosis, Spinal/*etiology, Adult ; Antitubercular Agents/administration & dosage ; Antitubercular Agents/therapeutic use ; Humans ; Magnetic Resonance Imaging ; Male ; Mycobacterium tuberculosis/isolation & purification ; Sacrum/diagnostic imaging ; Sacrum/pathology ; Tuberculosis, Meningeal/complications ; Tuberculosis, Pulmonary/classification ; Tuberculosis, Spinal/cerebrospinal fluid
مستخلص: 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.
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المشرفين على المادة: 0 (Antitubercular Agents)
تواريخ الأحداث: Date Created: 20200603 Date Completed: 20200619 Latest Revision: 20240328
رمز التحديث: 20240329
مُعرف محوري في PubMed: PMC7249907
DOI: 10.1097/MD.0000000000020012
PMID: 32481268
قاعدة البيانات: MEDLINE
الوصف
تدمد:1536-5964
DOI:10.1097/MD.0000000000020012