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Joint Bone Spine
Volume 74, Issue 3, May 2007, Pages 292-295
 
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doi:10.1016/j.jbspin.2006.06.010    
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Copyright © 2007 Elsevier Masson SAS All rights reserved.

Case report

Lymph node paradoxical enlargement during treatment for tuberculous spondylodiscitis (Pott's disease)

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Antoine Froissarta, Christian Pagnouxb and Patrick Chérina, Corresponding Author Contact Information, E-mail The Corresponding Author

aService de Médecine Interne I, Assistance Publique – Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, 47–83 boulevard de l'Hôpital, 75013 Paris, France

bService de Médecine Interne, Assistance Publique – Hôpitaux de Paris, Hôpital Cochin, Université Paris 5, 27, rue du Faubourg Saint-Jacques, 75679 Paris Cedex 14, France


Received 29 March 2006; 
accepted 28 June 2006. 
Available online 5 February 2007.

Abstract

Introduction

Paradoxical reactions during adapted antituberculous treatment are defined as a transient, clinical and/or radiological enlargement of pre-existent lesions or appearance of new ones.

Observation

We report herein the case of a 62-year-old woman who suffered under treatment of Pott's disease from an enlargement of her para-vertebral abscess and disco-vertebral lesions, and a tuberculous paradoxical reaction characterized by the development of uni- then bilateral cervical lymph nodes. Outcome was favourable after drainage by percutaneous punction of the adenopathies and oral short course of corticosteroids, and the continuation of combined antituberculous therapy.

Conclusion

Paradoxical reactions under adapted antituberculous treatment must be considered only after excluding an inadequate or irregular intake, or absorption of antituberculous drugs. This phenomenon is not rare, and has been reported even in ten to 15% of the patients not infected with the human immunodeficiency virus. The adjunction of a short course of corticosteroids may be necessary and rapidly efficient to control these reactions, in combination with surgical or percutaneous drainage of the enlarged lymph nodes, to avoid unfavourable and/or unaesthetic fistulisations.

Keywords: Tuberculosis; Paradoxical reaction; Tuberculous spondylodiscitis; Pott's disease

Article Outline

1. Introduction
2. Observation
3. Discussion
References




Corresponding Author Contact InformationCorresponding author. Tel.: +33 01 4216 1075; fax: +33 01 4216 1065.

Joint Bone Spine
Volume 74, Issue 3, May 2007, Pages 292-295
 
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