STUDY OF PARADOXICAL RESPONSE TO CHEMOTHERAPY IN TUBERCULOUS PLEURAL EFFUSION

Background: Paradoxical worsening nf disease in spite nf effective che motherapy for tuberculosis, has been reported to occur in cases of int racranial tuberculoma, lymph node, and pulmonary tuberculosis. However , only rare case reports describe such paradoxical response in tubercu losis pleurisy. Methods: Sixty-one patients with proven tuberculous pl eural effusion were retrospectively screened in Riyadh, Saudi Arabia, in three major hospitals to look systematically at the incidence and f eatures of paradoxical response. Results: Paradoxical increase in the size of the effusion was detected in 10 of 61 patients. In six patient s, the effusion became massive with worsening of dyspnoea requiring th e use of corticosteroids in five patients and therapeutic aspiration i n all six. However, complete resolution occurred in all 10 patients wi thin 1-3 months. Three out of the 10 patients developed residual pleur al thickening. Conclusion: An incidence of 16% (10/61) paradoxical wor sening 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.