1627. Incidence and Outcome of Post-therapy Paradoxical Lymph Node Enlargement after Completing Tuberculosis Treatment
Session: Poster Abstract Session: Mycobacterial Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • presentation number 1627.pdf (3.3 MB)
  • Background: Physicians occasionally encounter post-therapy lymphadenopathy after completing effective tuberculosis (TB) treatment. Limited data are available on the incidence and outcome of post-therapy lymphadenopathy after completing TB treatment.

    Methods: We prospectively evaluated incidence and outcome of post-therapy lymphadenopathy in new patients with lymph node TB (group 1) and in previously TB-treated patients (group 2). Outcomes were determined as following criteria: microbiological recurrence, clinical recurrence, and post-therapy paradoxical response (PR) (no microbiological recurrence and spontaneous improvement without further TB treatment).

    Results: A total of 154 new patients with lymph node TB (group 1) were followed for a median of 24 months after completing TB treatment. Of the 154 patients, 24 patients (15.6%; 95% CI 3.7% to 17.7%) experienced post-therapy lymphadenopathy. Median time to onset of post-therapy lymphadenopathy after completing treatment was 4 months (interquartile range, 2–14). Twelve previously TB-treated patients visited our clinic for suspected lymph node TB (group 2). Of these 36 patients of post-therapy lymphadenopathy (groups 1 and 2), rebiopsy was performed in 23 patients. Four samples (17.4%) were positive for AFB stain and 11 (47.8%) were positive for TB-PCR, but all sample were sterile. Granuloma was present on 13 (52.2%) histological specimens. Of these 36 patients, 33 (91.7%) were improved without retreatment (post-therapy PR) and 3 (8.3%) were improved with retreatment (clinical recurrence). The overall incidence of post-therapy PR in new patients with lymph node TB (group 1) was 8.6 per 100 person-years (95% CI, 5.8–12.7).

    Conclusion: We found that substantial portion of lymph node enlargement after completing TB treatment is more likely associated with post-therapy PR rather than with microbiological recurrence. Our data suggest that patients with negative cultures of rebipsy samples and good compliance to initial therapy may be observed until post-therapy PR resolves. To avoid unnecessary prescribing anti-TB medication, clinicians should be aware of the possibility of post-therapy PR in patients with lymphadenopathy after completing TB treatment.

    Ki-Ho Park, MD1, Mi Suk Lee, MD1, Sang-Oh Lee, MD2, Sang-Ho Choi, MD2, Yang Soo Kim, MD2, Jun Hee Woo, MD2 and Sung-Han Kim, MD2, (1)Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea, (2)Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea


    K. H. Park, None

    M. S. Lee, None

    S. O. Lee, None

    S. H. Choi, None

    Y. S. Kim, None

    J. H. Woo, None

    S. H. Kim, None

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