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Azoulay LD, Houist AL, Feredj E, Vindrios W, Gallien S. [Paradoxical tuberculosis reaction]. Rev Med Interne 2024:S0248-8663(24)00028-6. [PMID: 38267320 DOI: 10.1016/j.revmed.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 12/20/2023] [Accepted: 01/09/2024] [Indexed: 01/26/2024]
Abstract
Paradoxical tuberculosis reaction is defined as the aggravation of lesions present at diagnosis or the development of new lesions under anti-tuberculosis treatment, after exclusion of other alternate causes. It affects 5 to 30% of tuberculosis patients, with a variable prevalence depending on the site of infection and the clinical background. The diagnosis of paradoxical reaction is one of elimination, and requires having ruled out therapeutic failure, notably linked to poor compliance and/or to the presence of mycobacterial antibiotic resistance. The severity of paradoxical tuberculosis reaction lies in its neurological impairment. Despite its clinical importance, the mechanisms involved remain poorly understood and its management is not consensual. Corticosteroids are the cornerstone in the medical management. The role of anti-TNF agents, currently proposed in cases of corticodependence or corticoresistance, remains to be properly defined.
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Affiliation(s)
- L-D Azoulay
- Service de maladies infectieuses et d'immunologie clinique, CHU de Henri-Mondor, AP-HP, Créteil, France.
| | - A-L Houist
- Service de maladies infectieuses et d'immunologie clinique, CHU de Henri-Mondor, AP-HP, Créteil, France
| | - E Feredj
- Service de maladies infectieuses et d'immunologie clinique, CHU de Henri-Mondor, AP-HP, Créteil, France
| | - W Vindrios
- Service de maladies infectieuses et d'immunologie clinique, CHU de Henri-Mondor, AP-HP, Créteil, France
| | - S Gallien
- Service de maladies infectieuses et d'immunologie clinique, CHU de Henri-Mondor, AP-HP, Créteil, France
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Caradec E, Mouren D, Zrounba M, Azoulay LD, Blandin C, Ivanoff S, Levy V, Brillet PY, Nunes H, Uzunhan Y. COVID-19 in a patient with idiopathic pulmonary fibrosis successfully treated with Ruxolitinib. Respir Med Res 2020; 79:100799. [PMID: 33242734 PMCID: PMC7647390 DOI: 10.1016/j.resmer.2020.100799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/01/2020] [Accepted: 10/14/2020] [Indexed: 01/20/2023]
Affiliation(s)
- E Caradec
- Centre Constitutif de référence des maladies pulmonaires rares, AP-HP, Service de Pneumologie, Hôpital Avicenne, Bobigny, France
| | - D Mouren
- Centre Constitutif de référence des maladies pulmonaires rares, AP-HP, Service de Pneumologie, Hôpital Avicenne, Bobigny, France
| | - M Zrounba
- Centre Constitutif de référence des maladies pulmonaires rares, AP-HP, Service de Pneumologie, Hôpital Avicenne, Bobigny, France
| | - L-D Azoulay
- Centre Constitutif de référence des maladies pulmonaires rares, AP-HP, Service de Pneumologie, Hôpital Avicenne, Bobigny, France
| | - C Blandin
- Centre Constitutif de référence des maladies pulmonaires rares, AP-HP, Service de Pneumologie, Hôpital Avicenne, Bobigny, France
| | - S Ivanoff
- AP-HP, Hôpital Avicenne, Service d'Hématologie, Bobigny, France
| | - V Levy
- AP-HP, Hôpital Avicenne, Service d'Hématologie, Bobigny, France
| | - P-Y Brillet
- AP-HP, Hôpital Avicenne, Service de Radiologie, Bobigny, France; Université Sorbonne Paris Nord, INSERM U1272, Bobigny, France
| | - H Nunes
- Centre Constitutif de référence des maladies pulmonaires rares, AP-HP, Service de Pneumologie, Hôpital Avicenne, Bobigny, France; Université Sorbonne Paris Nord, INSERM U1272, Bobigny, France
| | - Y Uzunhan
- Centre Constitutif de référence des maladies pulmonaires rares, AP-HP, Service de Pneumologie, Hôpital Avicenne, Bobigny, France; Université Sorbonne Paris Nord, INSERM U1272, Bobigny, France.
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