[A CASE OF LYMPH NODE TUBERCULOSIS ASSOCIATED WITH A FLUID-FILLED MASS IN THE THORACIC WALL DUE TO A PARADOXICAL RESPONSE TO THERAPY].

Abstract

A 72-year-old man was admitted to our hospital in November 201X- 1 because of fever and left cervical lymph node swelling. Chest computed tomography (CT) confirmed left swelling in the cervical lymph node and the axillary lymph node. We performed a lymph node biopsy and diagnosed tuberculosis of the lymph nodes (the left cervical region and the axilla). The patient was treated with anti-tuberculosis drugs (isoniazid, rifampicin, ethambutol, and pyrazinamide) in December 14, 201X-1. After initiating the therapy, the fever resolved, and his general conditions gradually improved. Thus, the patient recovered well because of the anti-tubercu- losis therapy. Despite maintaining good general conditions, the patient experienced increasing swelling in his left hemi- thorax around the end of January 201X. A chest CT showed a clear fluid-filled mass in the left thoracic wall. Microscopic examination of the specimen obtained by CT-guided needle biopsy showed positive results for acid-fast bacteria and polymerase chain reaction for Mycobacterium tuberculosis indicated that the anti-tuberculosis therapy had failed. How- ever, the patient's general conditions remained good, and the results of blood laboratory tests were stable. Thus, we concluded that the mass was the result of a paradoxical response to the anti-tuberculosis therapy, and we reinstated the same therapy. Although the fluid-filled mass recurred in the same region less than a month following the first anti-tuberculosis therapy, the mass spontaneously regressed when the therapy was reinstated. Thus, we confirmed that a paradoxical response was the cause of the clinical course in this patient.