Paradoxical Reactions in Tuberculosis : Clinicians Burnout

Abstract

We want to make our observations regarding worsening of clinical and radiologic features in a patient of potts spine after institution of antitubercular therapy. The index case is 34 year old male presented with pain in lower back and fever for past many months. Clinical examination revealed febrile, weak and anxious person with normal clinical examination. His investigations revealed Hb 11.8 mg/dl, TLC, DLC, platelet count normal. ESR was 52 mm at 1^st hour and Mantoux was 12 mm at 72 hrs. CXR, USG abdomen were normal. Brucella agglutination titre was not suggestive for endemic area. Retroviral card test and serology was negative. MRI lumbosacral spine revealed spondodiscitis L2 and L3 vertebrae with large paraspinal collection. Patient underwent decompression surgery with removal of necrotic collection. Histocytology of the specimens revealed langerhan type gaint cells and caseous necrotic material. Patient was put on antitubercular treatment. Patient started with subjective worsening after 2 weeks of treatment when repeat imaging revealed accumulation of paraspinal collection with pressure on lower end of spinal cord and cauda equina. Patient antitubercular treatment were continued with addition of dexamethasone. The clinical scenario started improving after 5 days of institution of steroids. The steroids were continued for 4 weeks and then tapered over next 2 weeks. Patient started to show marked clinical improvement at 2 months. The intensive phase of antitubercular therapy was continued for additional one month and maintenance phase was given for 9 months. After one year of institution of treatment patient had no neurologic sequalae and complete radiologic resolution. JMS 2018: 21 (2):127-128