Paradoxical reaction associated with cervical lymph node tuberculosis: predictive factors and therapeutic management

- The predictors and management of paradoxical reaction have not been clarified.
- The main predictors of paradoxical reaction found in this study were lymph node size ≥3 cm and associated extra-lymph node tuberculosis.
- Management remains controversial, but surgery may be effective.

SummaryObjectivesThe aims of this study were to determine predictive factors of paradoxical reaction in patients with cervical lymph node tuberculosis (TB) and to discuss the therapeutic management of this condition.Materials and methodsA retrospective study was performed of 501 patients managed for cervical lymph node TB over a period of 12 years (from January 2000 to December 2011). Statistical data were analyzed using IBM SPSS Statistics version 20.0.ResultsParadoxical reaction occurred in 67 patients (13.4%), with a median delay to onset after starting TB treatment of 7 months. Lymph node size ≥3 cm and associated extra-lymph node TB were independently associated with paradoxical reaction. Treatment consisted of surgical excision (71.6%), restarting quadruple therapy (10.4%), reintroduction of ethambutol (23.8%), and addition of ciprofloxacin (20.8%); steroids were given in two cases . All patients recovered after an average treatment duration of 14.91 ± 7.03 months.ConclusionThe occurrence of paradoxical reaction in cervical lymph node TB seems to be predicted by associated extra-lymph node TB and a swelling size ≥3 cm. The treatment of paradoxical reaction remains unclear and more randomized trials are necessary to improve its management.