Paradoxical Deterioration During Anti-Tuberculous Therapy in Non-HIV-Infected Patients with Pleural Tuberculosis: A Pragmatic Approach

We report a case of paradoxical deterioration. A male patient diagnosed with pleural tuberculosis, but who was not infected with human immunodeficiency virus (HIV), experienced clinical deterioration 3 weeks after the initiation of anti-tuberculous treatment. After other diagnoses were ruled out, a paradoxical response to treatment was established and the patient was started on systemic corticosteroids. Paradoxical response to treatment should be considered in patients with clinical deterioration after they start on anti-tuberculous treatment. LEARNING POINTS: The deterioration of patients with pleural tuberculosis during anti-tuberculous treatment should raise the suspicion of paradoxical response to treatment. Despite the clinical deterioration, patients should be kept on anti-tuberculosis treatment. There is no clear evidence concerning the benefits and harms of systemic corticosteroids or pleural drainage as additional treatment to control the patient’s symptoms in this scenario.