Multifocal Tuberculosis with Prolonged Paradoxical Reaction: A Case Report

Copyright: ©Th e Author(s), YEAR. Publisher. Th e Journal of King Abdualziz University Medical Sciences is an Offi cial Publication of “King Abdulaziz University”. It is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permit unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract This is a case report describing successful treatment of a challenging case of an 18-year old previously healthy high school male student with multifocal tuberculosis involving the spleen and mediastinal and abdominal lymph nodes confi rmed by histopathology of splenectomy tissue. The patient initially responded well to antituberculosis therapy with complete resolution of fever and improvement in his general health and weight. However, two months after initiation of anti-tuberculosis therapy, the patient developed paradoxical reaction manifest as recurrence of fever that persisted for fi ve months and was associated with enlargement of lymph nodes. The fever failed to abate with continuation of the same antituberculosis therapy. Despite reassurance that the fever was due to a prolonged paradoxical reaction, a decision was made by the family to seek advice in another hospital where lymphoma was excluded again by histopathological examination of an excisional lymph node biopsy that revealed caseating granulomatous lymphadenitis and negative tuberculosis stain, culture, and polymerase chain reaction. The patient was continued on anti-tuberculosis therapy and treated with corticosteroids that resulted in complete resolution of fever and subsequent full recovery from his tuberculosis.