Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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A Case of Different Response of Miliary Lung and Intracranial Nodules to Antituberculous Therapy

항결핵제에 다른 반응을 보인 속립성 폐 결절과 두개강내 결절 1예

  • Park, Kwang Young (Department of Internal Medicine, Korea Cancer Center Hospital) ;
  • Lee, Ho Jin (Department of Internal Medicine, Korea Cancer Center Hospital) ;
  • Jung, Jae Wook (Department of Internal Medicine, Korea Cancer Center Hospital) ;
  • Choi, Yoon Hee (Department of Internal Medicine, Korea Cancer Center Hospital) ;
  • Nam, Seung Bum (Department of Internal Medicine, Korea Cancer Center Hospital) ;
  • Ahn, Se Han (Department of Internal Medicine, Korea Cancer Center Hospital) ;
  • Kim, Cheol Hyeon (Department of Internal Medicine, Korea Cancer Center Hospital) ;
  • Lee, Jae Cheol (Department of Internal Medicine, Korea Cancer Center Hospital)
  • Received : 2007.06.14
  • Accepted : 2008.02.01
  • Published : 2008.02.28
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Abstract

Although a paradoxical response of tuberculosis to antituberculous therapy is not a rare phenomenon, it can be a clinical challenge to differentiate a paradoxical response from treatment failure. A 25-year-old woman was admitted for miliary lung nodules and multiple intracranial nodules. Antituberculous treatment was started with a preliminary diagnosis of tuberculosis based on the history and clinical findings. After one month, the military lung nodules improved while the intracranial nodules increased in size and number. Based on a stereotactic biopsy, it was confirmed that the intracranial lesions were tuberculomas. Although the therapeutic regimen was not changed, the symptoms eventually were ameliorated and the intracranial nodules improved two months later.

항결핵제 치료 도중 병변이 악화되거나 새로 생기는 경우 일시적인 역설적 반응과 치료 실패를 감별하는 것이 중요하다. 역설적인 반응은 폐외 결핵, 특히 림프절과 중추신경계 결핵에서 잘 나타나는데 기존의 약제를 그대로 사용하더라도 일반적으로 잘 치유가 된다. 저자들은 속립성 폐결절이 항결핵제 투여 후 호전되고 있었으나 두개강내 결절은 오히려 악화된 소견을 보였지만 치료 약제를 변경하지 않았음에도 결국 치유된 역설적 반응을 경험하였기에 이를 보고하는 바이다.

Keywords

References

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