ReviewIrish journal of medical science2026
Paradoxical reactions during treatment of miliary tuberculosis: a 25-year single-centre case series and literature review.
Review in Irish journal of medical science, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundParadoxical reactions during otherwise effective anti-tuberculosis treatment can resemble treatment failure or drug resistance. Their frequency and clinical spectrum in miliary tuberculosis are incompletely characterised.
aimsTo describe the timing, manifestations, management and outcomes of paradoxical reactions identified in a defined cohort of patients with miliary tuberculosis and to place these events in the context of the published literature.
methodsWe retrospectively reviewed the records of 63 patients with miliary tuberculosis managed at a single centre between 1981 and 2005. A paradoxical reaction was defined as clinical or radiological worsening of an initially improving lesion, or development of a new lesion during appropriate therapy, after reasonable exclusion of treatment failure, drug resistance and alternative diagnoses.
resultsFive of 63 patients (7.9%) developed six paradoxical reaction episodes. Manifestations included multiple subcutaneous abscesses, two small-intestinal perforations, two spontaneous pneumothoraces and progression of miliary nodules with new cavitary lesions. Reactions occurred 10-240 days after treatment initiation (median, 108 days). Five episodes required surgical or interventional management. The anti-tuberculosis regimen was continued without modification in every episode. One patient developed two reactions despite corticosteroid treatment for systemic lupus erythematosus. All patients recovered, with no recurrence during 4-24 months of follow-up.
conclusionsParadoxical reactions in miliary tuberculosis may be anatomically diverse and life-threatening. Recognition of this pattern, together with careful exclusion of microbiological failure, can prevent unnecessary alteration of effective treatment while ensuring timely management of site-specific complications.
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