Paradoxical reaction associated with cervical lymph node tuberculosis: predictive factors and therapeutic management.
OBJECTIVES
The 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 METHODS
A 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.


RESULTS
Paradoxical reaction occurred in 67 patients (13.4%), with a median delay to onset after starting TB treatment of 7 months. Lymph node size ≥3cm 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.


CONCLUSION
The occurrence of paradoxical reaction in cervical lymph node TB seems to be predicted by associated extra-lymph node TB and a swelling size ≥3cm. The treatment of paradoxical reaction remains unclear and more randomized trials are necessary to improve its management.
['Chahed|Houda|H|', 'Hachicha|Hela|H|', 'Berriche|Aida|A|', 'Abdelmalek|Rim|R|', 'Mediouni|Azza|A|', 'Kilani|Badreddine|B|', 'Amor|Mohamed Ben|MB|', 'Benaissa|Hanene Tiouiri|HT|', 'Besbes|Ghazi|G|']
D000328:Adult D000900:Anti-Bacterial Agents D000995:Antitubercular Agents D002939:Ciprofloxacin D019468:Disease Management D004977:Ethambutol D005260:Female D006801:Humans D008198:Lymph Nodes D008297:Male D008875:Middle Aged D012189:Retrospective Studies D016896:Treatment Outcome D014388:Tuberculosis, Lymph Node D055815:Young Adult
Paradoxical reaction Cervical lymph node Tuberculosis Treatment