Paradoxical reaction manifesting as new pulmonary nodules emerging synchronously and sequentially in the lung ipsilateral to pleural effusion in an HIV-negative patient with tuberculous pleuritis: A case report.
- 1Department of Infectious Diseases, The People's Hospital of Leshan, Leshan, 614000, Sichuan province, China.
- 2Department of Nephrology, The People's Hospital of Leshan, Leshan, 614000, Sichuan province, China.
- 3The Key Laboratory of Infectious and Parasitic Diseases in Chongqing, Infectious Disease Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
Abstract
Paradoxical reaction (PR) refers to an abnormal and exaggerated immune response triggered by viable or nonviable Mycobacterium tuberculosis. This reaction can develop during or after standard antituberculous therapy (ATT), more frequently in HIV-positive individuals and occasionally in HIV-negative ones. Pulmonary nodules are a rare presentation of PR, which is easily misdiagnosed as pulmonary malignancy, fungal infection and other thoracic diseases. Herein we present a 19-year-old HIV-negative young male with right tuberculous pleuritis who underwent standardized ATT. Three months into treatment, routine chest computed tomography (CT) detected multiple new pulmonary nodules on the affected side. CT-guided percutaneous lung biopsy confirmed caseating granulomatous inflammation. After ruling out other potential etiologies, the patient was diagnosed with a tuberculous paradoxical reaction. The original ATT regimen was maintained. During follow-up, three pre-existing nodules in the right lung gradually regressed, while one enlarged and an additional nodule developed. The patient was asymptomatic and declined further examinations, and the initial ATT regimen continued. He eventually finished the full 12-month ATT course. Nine months after treatment completion, the majority of lesions resolved nearly completely. Clinicians should be highly alert to paradoxical reaction when new pulmonary nodules emerge synchronously or asynchronously in the ipsilateral lung with pleural effusion among tuberculous pleurisy patients on ATT. The diagnosis depends on the exclusion of alternative causes. For asymptomatic patients, the original ATT regimen should be continued. Long-term regular follow-up is essential.
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BibTeX
@article{xiong2026paradoxical,
title = {{Paradoxical reaction manifesting as new pulmonary nodules emerging synchronously and sequentially in the lung ipsilateral to pleural effusion in an HIV-negative patient with tuberculous pleuritis: A case report.}},
author = {Yujiao Xiong and Yongqiang Bao and Bei Jia},
journal = {Respiratory medicine case reports},
year = {2026},
month = oct,
doi = {10.1016/j.rmcr.2026.102527},
url = {https://europepmc.org/article/MED/42999857},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Paradoxical reaction manifesting as new pulmonary nodules emerging synchronously and sequentially in the lung ipsilateral to pleural effusion in an HIV-negative patient with tuberculous pleuritis: A case report.
AU - Yujiao Xiong
AU - Yongqiang Bao
AU - Bei Jia
PY - 2026
DA - 2026/10/28
JO - Respiratory medicine case reports
DO - 10.1016/j.rmcr.2026.102527
UR - https://europepmc.org/article/MED/42999857
AB - Paradoxical reaction (PR) refers to an abnormal and exaggerated immune response triggered by viable or nonviable Mycobacterium tuberculosis. This reaction can develop during or after standard antituberculous therapy (ATT), more frequently in HIV-positive individuals and occasionally in HIV-negative ones. Pulmonary nodules are a rare presentation of PR, which is easily misdiagnosed as pulmonary malignancy, fungal infection and other thoracic diseases. Herein we present a 19-year-old HIV-negative young male with right tuberculous pleuritis who underwent standardized ATT. Three months into treatment, routine chest computed tomography (CT) detected multiple new pulmonary nodules on the affected side. CT-guided percutaneous lung biopsy confirmed caseating granulomatous inflammation. After ruling out other potential etiologies, the patient was diagnosed with a tuberculous paradoxical reaction. The original ATT regimen was maintained. During follow-up, three pre-existing nodules in the right lung gradually regressed, while one enlarged and an additional nodule developed. The patient was asymptomatic and declined further examinations, and the initial ATT regimen continued. He eventually finished the full 12-month ATT course. Nine months after treatment completion, the majority of lesions resolved nearly completely. Clinicians should be highly alert to paradoxical reaction when new pulmonary nodules emerge synchronously or asynchronously in the ipsilateral lung with pleural effusion among tuberculous pleurisy patients on ATT. The diagnosis depends on the exclusion of alternative causes. For asymptomatic patients, the original ATT regimen should be continued. Long-term regular follow-up is essential.
SN - 2213-0071
ER -