• Journal of Korean Neurosurgical Society
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• v.41 no.6
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• pp.408-410
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• 2007

"Paradoxical deterioration" during antituberculous therapy is generally defined as the clinical or radiological worsening of pre-existing tuberculous lesions or the development of new lesions in a patient who initially improves. The phenomenon of paradoxical deterioration in intramedullary tuberculoma of the spinal cord is rare and is a less established entity. The authors present an unusual case of paraparesis as a result of paradoxical deterioration of intramedullary tuberculoma despite adequate antituberculous therapy. Here, we review the relevant literatures and discuss its possible pathogenic mechanisms.

• Tuberculosis and Respiratory Diseases
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• v.51 no.3
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• pp.260-264
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• 2001

Background : Paradoxical intracranial tuberculoma is tuberculoma that developed or was enlarged during antituberculous therapy. The course of the disease or effective treatment are not well known. Method : Patients who developed intracranial tuberculoma or an enlarged tuberculoma during antituberculous therapy were investigated. Ten patients were enrolled. Result : Paradoxical intracranial tuberculoma was detected 67.9 days after antituberculous therapy. The symptoms worsened over a period of 102.3 days. Improvement was noted after 165.4 days. Four patients recovered on the brain image and 4 recovered clinically. The CSF findings showed that the paradoxical tuberculomas had developed or were aggravated, the CSF findings was aggravated. Conclusion : Paradoxical intracranial tuberculoma can develop without specific symptoms. Paradoxical intracranial tuberculoma may not be a paradoxical response and may be a natural course of intracranial tuberculosis or a natural response to antituberculous therapy.

• Tuberculosis and Respiratory Diseases
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• v.57 no.3
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• pp.226-233
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• 2004

Background : Interferon-gamma (IFN-${\gamma}$) is a critical cytokine in the defense against a Mycobacterium tuberculosis infection. Even though IFN-${\gamma}$ has occasionally been used in the treatment of refractory multidrug-resistant tuberculosis (MDR-TB) with some promising results, there is still some controversy regarding the therapeutic efficacy of IFN-${\gamma}$. This study was performed to examine the effect of subcutaneous IFN-${\gamma}$ in the treatment of MDR-TB patients. Methods : Six patients with refractory MDR-TB were enrolled in this study. Two million IU of IFN-${\gamma}$ was administered subcutaneously three times a week with the concomitant administration of antituberculous drugs for at least for 28 weeks. During the IFN-${\gamma}$ therapy, the sputum smear and culture, radiological and clinical evaluations were performed every 4 weeks throughout the study period. Results : The mean age of the 6 patients was 37 years (ranges, 15-61 years). The drug susceptibility test to standard antituberculous drugs revealed resistance to an average of 6.8 (${\pm}1.2$) agents including isoniazid and rifampicin. An average of 10.8 (${\pm}1.3$) antituberculous drugs were prescribed before IFN-${\gamma}$ therapy. The culture became negative in 2 patients (33%) after initiating IFN-${\gamma}$ therapy; one at 8 weeks, and the other at 24 weeks. Finally, after stopping the IFN-${\gamma}$ therapy after 28 weeks, the culture became positive again in the two patients who were culture-negative. The other 4 patients who failed in the culture conversion are still on antituberculous treatment except for one who died of tuberculosis. Conclusion : Even though 28 weeks of subcutaneous IFN-${\gamma}$ therapy in combination with antituberculous drugs was successful in inducing the culture-negative conversion in some patients with refractory MDR-TB, the culture became positive again after stopping the IFN-${\gamma}$ therapy. This suggests that subcutaneous IFN-${\gamma}$ therapy may have suppressive effect on tuberculosis only during the IFN-${\gamma}$ therapy period in some patients. Further studies will be needed to determine the optimum dose, the administration route, the duration of therapy, and the predicting factors of the response to adjuvant IFN-${\gamma}$ therapy.

• Tuberculosis and Respiratory Diseases
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• v.59 no.2
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• pp.179-185
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• 2005

Background : To evaluate the clinical efficacy of pulmonary resection combined with first-line antituberculous drug therapy in patients with well-localized, cavities-containing pulmonary multidrug-resistant tuberculosis (MDR-TB). Method : From February 1998, seventeen patients with well-localized, cavities-containing pulmonary MDR-TB were enrolled and followed prospectively up to December 2004. After radical pulmonary resection, the patients were treated with antituberculous drugs comprising of isoniazid (H), rifampin (R), pyrazinamide (Z), ethambutol (E), and streptomycin (S) (3HERZS/3HERS/6HER). Results : All recovered isolates of M. tuberculosis were resistant to both isoniazid and rifampin, and to a mean of 4.8 antituberculous drugs (range, 2 to 7 drugs). Surgical procedures included lobectomy (13 patients), lobectomy plus segmentectomy (3 patients), and pneumonectomy (1 patient). The median time for postoperative sputum smear and culture conversion was 2 days (range, 1 to 23 days). Fifteen (94%) patients had durable cures (mean follow-up period, 39.0 months). One patient failed to convert her sputum and was successfully switched to second-line therapy; one patient developed active disease again almost 7 years later, likely due to re-infection with a new M. tuberculosis strain. Conclusion : Radical resection combined with administration of first-line antituberculous agents was effective in patients with well-localized, cavities-containing pulmonary MDR-TB.

• Tuberculosis and Respiratory Diseases
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• v.64 no.2
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• pp.153-157
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• 2008

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.

• Journal of Chest Surgery
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• v.29 no.11
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• pp.1284-1287
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• 1996

Esophagobronchial fistula is an uncommon complication of tuberculous lymphadenitis and usually requires surgical treatment in addition to antituberculosis medication. A case of tuberculous esophagobronchial fistula was healed effectively with antituberculous therapy alone.

• Clinical and Experimental Pediatrics
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• v.45 no.12
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• pp.1596-1600
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• 2002

A 23-month-old girl visited with chronic cough and her chest radiograph showed miliary tuberculosis. There was no neurological abnormality. But CSF findings showed WBC $22/mm^3$(lymphocyte 20%, neutrophil 80%) and positive result of polymease chain reaction(PCR) for M. tuberculosis. MR imaging showed multiple ring enhanced nodules and ovoid nonenhancing bright signal lesion on the cerebrum, cerebellar parenchyme, and left basal ganglia. Antituberculous chemotherapy was done and follow-up MR imaging was done after six months. One month after treatment, the number and size of nodules had decreased. Six months after treatment, the multiple enhanced nodules and leptomeningeal enhancement were not observed, and high signal intensity of genu portion of left internal capsule and posterior portion of putamen were decreased.

• Journal of Acupuncture Research
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• v.32 no.3
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• pp.221-227
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• 2015

Objectives : The purpose of this study is to report the clinical effects of Integrated Medicine Therapy on Tuberculous Spondylitis. Methods : The patient was diagnosed with Tuberculous Spondylitis by MRI. Despite taking antituberculous drugs for one month the back pain remained. As a result the patient was hospitalized shortly thereafter in our hospital, and was treated with acupuncture, pharmacopuncture, and herbal medication during the admission period. The clinical effects of these treatments are measured by the verbal rating scale(VRS), the range of motion(ROM) and the Korean oswestry disability index(KODI). Results : VRS is changed from 10 to 3.5, limited lumbar ROM recovered, KODI changed from 85.71 to 28.57. Conclusions : These results suggest that integrated medicine therapy may be effective for tuberculous spondylitis.

• Tuberculosis and Respiratory Diseases
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• v.39 no.4
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• pp.355-360
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• 1992

Nocardiosis is an acute, subacute or chronic infection, which usually introduced through the respiratory tract resulting pneumonia, and may develop a disseminated infection, especially subcutaneous abscess and/or CNS infection. It is usually affects the immunocompromized host and may be fatal unless early diagnosis and adequate treatment are performed. There have been only several case reports of nocardial infection in Korea. Nocardiosis is so unfamiliar to many physicians that may be misdiagnosed as pneumonia, tuberculosis, or neoplasm. We have experienced a case of nocardiosis from a patient who had been treated as pneumonia and tuberculosis at first. The 57-year-old male patient had fever, chill, dyspnea and blood tinged purulent sputum for 20 days. Under the impression of bacterial pneumonia, broad spectrum antibiotics were administered for more than 3 weeks without clinical improvement. Although antituberculous drugs began to be administered after acid fast bacilli were found in bronchial aspirate by bronchoscopy, the nocardial infection was suspected due to no clinical response toward antituberculous therapy and the occurrence of multiple subcutaneous abscesses on scalp. The diagnosis was made by modified Ziehl-Neelson stain and culture of the sputum and pus. Nocardia asteroides was identified. After 25 days of trimethoprim-sulfamethoxazole treatment, the patient was much improved and discharged.

• Tuberculosis and Respiratory Diseases
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• v.45 no.5
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• pp.935-941
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• 1998

Background: As living and dead Mycobacteria could be amplified by polymerase chain reaction(PCR), it was considered that PCR was inappropriate for the monitoring of pulmonary tuberculosis after treatment. But we found negative conversion of PCR after successful treatment. We would like to know about the negative conversion rate of PCR and its conversion time after antituberculous treatment. Methods: We collected 113 sputums from the 16 patients of pulmonary tuberculsosis visiting Catholic University Hospital of Taegu Hyosung. We consecutively tested AFB smear, AFB culture and PCR by 2 to 4 weeks after antituberculous therapy. The patients were classified according to the chest X ray findings. Results: We detected negative conversion of PCR from all 16 patients of the pulmonary tuberculosis within 30 weeks after treatment. The average negative conversion time was $16{\pm}8$ weeks. The conversion time according to the chest X -ray findings were as follows : For the 8 cases of minimum were $9{\pm}5$ weeks, 4 cases of modreate advanced were $20{\pm}8$ weeks, and 4 cases of far advanced were $23{\pm}2$ weeks. The product of PCR was gradually decreased according to the duration of treatment. Conclusions: From the results of our study, we could utilize M. tubercuosis PCR for the prediction of therapy response and monitoring of the patient with pulmonary tuberculosis after treatment.