Varied Presentations of Paradoxical Upgrading Reactions in Pulmonary Tuberculosis.

Dr. Urvinderpal Singh; Dr. Navdeep Singh; Dr. Vinay Mohan; Dr. Hitesh Gour; Dr. Daksh Jhim; Dr. Muralidharan Ramaraj; Dr. Areekkara Poduvattil Prasanth; Dr. Shailly Deshawar; Dr Baljeet Singh Virk

Volume : V, Issue : XII, December - 2016

Varied Presentations of Paradoxical Upgrading Reactions in Pulmonary Tuberculosis.

Dr. Urvinderpal Singh, Dr. Navdeep Singh, Dr. Vinay Mohan, Dr. Hitesh Gour, Dr. Daksh Jhim, Dr. Muralidharan Ramaraj, Dr. Areekkara Poduvattil Prasanth, Dr. Shailly Deshawar, Dr Baljeet Singh Virk

Abstract :

Paradoxical Upgrading Reactions (PUR), usually observed in patients undergoing treatment for tuberculosis, is a phenomenon, characterized by transient worsening of both, the clinical symptoms and the lesions during appropriate anti–tubercular therapy. This reaction is mostly observed in cases of Tubercular lymphadenitis and less frequently in Pulmonary Tuberculosis. The reaction is related to hypersensitivity response to dying mycobacteria. These pose a challenge to the physicians to exclude all the causes/reasons (drug–resistant tuberculosis, non–compliance to the prescribed regimen or concomitant disorders unrelated to Tuberculosis) known to be responsible for worsening of the condition of the patient before classifying them as PUR. We report four cases of tuberculosis (two cases of pulmonary tuberculosis, one case each of tubercular lymphadenitis and tubercular pleural effusion) who, during the course of treatment presented with varied symptoms and presence of new lesions. After detailed investigations, it was inferred that worsening of symptoms and appearance of new lesions during treatment, were due to Paradoxical upgrading reactions, a phenomenon observed in 20–30% patients of Tuberculosis. This happening, is generally self– limiting and resolves without serious sequelae