Paradoxical pericarditis in an immunocompetent patient with mediastinal tuberculous lymphadenitis and endobronchial TB: A case report

IF 1 Q4 INFECTIOUS DISEASES

IDCases Pub Date : 2025-01-01 DOI:10.1016/j.idcr.2025.e02363

Tomohiro Oba, Hidekazu Matsushima, Masako Amano, Keiichi Akasaka, Tomotaka Nishizawa

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Abstract

Background

Paradoxical reaction (PR) refers to a worsening of existing or new TB-related lesions after initiating effective anti-tuberculosis therapy. While commonly observed in lymph node or CNS TB, PR involving the pericardium is exceedingly rare in immunocompetent patients.

Case presentation

A 22-year-old Vietnamese man with mediastinal tuberculous lymphadenitis and endobronchial TB was started on standard anti-TB therapy. After initial improvement, he developed pericardial effusion three months into treatment. Cultures and PCR were negative, but elevated ADA levels were detected. Based on clinical course and exclusion of treatment failure or coinfection, paradoxical pericarditis was diagnosed. Corticosteroids and levofloxacin were added empirically, with resolution of symptoms.

Conclusion

This case highlights a rare extrapulmonary manifestation of PR, reinforcing the need to distinguish it from treatment failure or TB progression in immunocompetent hosts.

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纵隔结核性淋巴结炎合并支气管内结核的免疫功能正常患者的异位性心包炎一例报告

背景：矛盾反应（PR）是指在开始有效的抗结核治疗后，现有的或新的结核相关病变恶化。虽然常见于淋巴结或中枢神经系统结核，但累及心包的PR在免疫功能正常的患者中极为罕见。病例介绍：一名22岁的越南男子，患有纵隔结核性淋巴结炎和支气管内结核，开始接受标准的抗结核治疗。初步改善后，治疗3个月后出现心包积液。培养和PCR均为阴性，但检测到ADA水平升高。根据临床病程和排除治疗失败或合并感染，诊断为矛盾心包炎。经经验加用皮质类固醇和左氧氟沙星，症状得到缓解。结论本病例突出了一种罕见的PR肺外表现，加强了将其与免疫正常宿主治疗失败或结核病进展区分开来的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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