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    New onset of fever and lymphadenopathy in a patient on antitubercular treatment for tuberculous meningitis: Drug resistance or paradoxical response phenomenon?

    Authors:

    D. Majumdar ,

    School of Tropical Medicine, Kolkata, IN
    About D.
    Department of Tropical Medicine
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    S. Chakraborty,

    School of Tropical Medicine, Kolkata, IN
    About S.
    Department of Tropical Medicine
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    A. Naskar,

    School of Tropical Medicine, Kolkata, IN
    About A.
    Department of Tropical Medicine
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    M. K. Ghosh,

    School of Tropical Medicine, Kolkata, IN
    About M. K.
    Department of Tropical Medicine
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    B. Saha

    School of Tropical Medicine, Kolkata, IN
    About B.
    Department of Tropical Medicine
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    Abstract

    Central nervous system (CNS) involvement is one of the most devastating clinical manifestations of tuberculosis (TB) noted in 5 to 10% of patients with extra pulmonary TB and accounts for approximately 1% of all patients with TB. Clinical deterioration during treatment with anti-tuberculosis drugs (ATD) is not uncommon in immunocompetent persons. Possibilities include multi-drug resistant tuberculosis (MDR-TB), a paradoxical response or some other non-tubercularcauses of fever. Corticosteroids are considered tohave a beneficial effect in the management of paradoxical reactions. Immuno-modulatory drugs, including tumour necrosis factor-α antagonists, thalidomide and interferon-γ have beenused in isolated cases with more severe forms of paradoxical reactions.We report here a case of a 13 year old girl who while being treated for tubercular meningitis, developed high grade fever with lymphadenopathy. Her lymph node biopsy showed caseous necrosis with presence of AFB suggestive of a paradoxical reaction.

    Keywords: Paradoxical response, Immunocompetent, Tuberculosis, MDR TB
    How to Cite: Majumdar, D., Chakraborty, S., Naskar, A., Ghosh, M.K. and Saha, B., 2017. New onset of fever and lymphadenopathy in a patient on antitubercular treatment for tuberculous meningitis: Drug resistance or paradoxical response phenomenon?. Sri Lankan Journal of Infectious Diseases, 7(1), pp.58–62. DOI: http://doi.org/10.4038/sljid.v7i1.8123
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    Published on 04 May 2017.
    Peer Reviewed
    CC BY 4.0

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