Study of paradoxical response to chemotherapy in tuberculous pleural effusion

Background: Paradoxical worsening nf disease in spite nf effective chemotherapy for tuberculosis, has been reported to occur in cases of intracranial tuberculoma, lymph node, and pulmonary tuberculosis. However, only rare case reports describe such paradoxical response in tuberculosis pleurisy. Methods: Sixty-one patients with proven tuberculous pleural effusion were retrospectively screened in Riyadh, Saudi Arabia, in three major hospitals to look systematically at the incidence and features of paradoxical response. Results: Paradoxical increase in the size of the effusion was detected in 10 of 61 patients. In six patients, the effusion became massive with worsening of dyspnoea requiring the use of corticosteroids in five patients and therapeutic aspiration in all six. However, complete resolution occurred in all 10 patients within 1-3 months. Three out of the 10 patients developed residual pleural thickening. Conclusion: An incidence of 16% (10/61) paradoxical worsening of tuberculous effusion following the start of anti-tuberculous treatment has been documented. This resulted in respiratory distress necessitating therapeutic re-aspiration in six of 10 patients.