Paradoxical reaction in immunocompetent children with tuberculosis

• A paradoxical reaction (PR) is not an unusual occurrence in immunocompetent children with tuberculosis (TB); PR is defined as the clinical or radiological worsening of pre-existing TB lesions in a patient who has initiated anti-tuberculosis treatment.
• During the study period, five of 51 children diagnosed with TB matched the definition of PR (9.8%), consistent with the results of previous studies.
• There is no consensus regarding the use of corticosteroids in the treatment of PR.
• Steroid treatment was administered to all of the patients in this study, and all had a favourable outcome.

SummaryBackgroundA paradoxical reaction (PR) during anti-tuberculosis treatment is a phenomenon that is poorly studied in immunocompetent children. It is defined as a clinical or radiological worsening of pre-existing tuberculosis (TB) disease.MethodsA retrospective descriptive study of children younger than 14 years of age was performed; these children developed PR during the years 2009 to 2014, following a diagnosis of TB. Demographic characteristics, microbiological results, treatment and outcome data were collected.ResultsOf 51 children diagnosed with TB, five (9.8%) developed a PR; four of these children had pulmonary TB and the remaining patient had miliary TB with central nervous system involvement. The PR occurred at a median of 42 days (range 23–53 days) after initiating therapy. Corticosteroids were started when PR was suspected, at a median dose of 1 mg/kg/day. Clinical and radiological improvement was noted in all cases, with a median clinical regression time of 10.5 days (range 3–15 days) and a median radiological regression time of 45 days (range 26–105 days). No sequelae were described in any patient.ConclusionsPR in immunocompetent children during anti-tuberculosis treatment is not such an unusual reaction. Treatment with corticosteroids may be useful for the resolution of PR.