[Increase in size of lymph nodes or occurrence of new lymphadenopathy during antituberculosis chemotherapy: paradoxical response].

The aim of this letter was to present four more cases of tuberculosis (TB) in whom paradoxical response developed. These presented cases had not been mentioned in the manuscript namely "Paradoxical radiologic progression despite appropriate antituberculous therapy" published in Mikrobiyol Bul 2012; 46(2): 299-303. Paradoxical response was identified in these patients by exclusion of clinical deterioration during antituberculosis therapy such as secondary infections, inadequate anti-tuberculosis therapy as a result of drug resistance, poor compliance, and adverse reactions due to therapy. The first case had received treatment due to right paratracheal tuberculous lymphadenitis and lung TB, and who exhibited a progression in lymphadenopathy (LAP) in the 5th month of treatment. Upon the completion of treatment to one year, the lesions regressed however, right inguinal LAP developed after 20 months of initiation of therapy. Inguinal lymph node biopsy revealed tuberculous lymphadenitis and the adenopathy regressed without treatment. The second case was a patient with right paratracheal tuberculous lymphadenitis, whose lesions regressed at 3rd months of treatment. However, progression was detected in the lesions at 6th month of treatment and the treatment was prolonged to one year. The third case is the one to whom anti-TB treatment was initiated upon the diagnosis of right cervical tuberculous lymphadenitis. A new LAP developed at the left cervical site and the biopsy taken from the lesion revealed nothing diagnostic. The treatment was prolonged to one year and then ceased in this patient. The fourth case is the one to whom anti-TB treatment was initiated upon the diagnosis of lung TB and who developed right paratracheal LAP at the 4th month of treatment. The anti-TB treatment was prolonged to six months in this patient. These cases were presented to draw attention to paradoxical response which is originally known to occur primarily in HIV positive patients. However, it should be kept in mind that in TB endemic areas such as our country, paradoxical response can develop in HIV negative or non-immunocompromised TB patients.