결핵성 흉막염 치료 중 발생한 역설적 반응

Abstract

적절한 항결핵제로 치료하여 호전을 보이던 결핵 환자에서 치료 도중, 이전에 존재하던 결핵병변이 악화되거나 또는 새로운 병변이 발생하는 경우가 있는데 이를 항결핵제에 대한 ‘역설적 반응’이라 한다. 14세 여자 환자의 결핵성 흉막염 치료 중 역설적 반응이 발생하여 6주간의 스테로이드 투여와 지속적인 항결핵제 투여로 호전을 보였기에 관련문헌 고찰과 함께 보고하는 바이다.

It is defined as the paradoxical response when the clinical or radiologic worsening of old lesions or the development of new lesion occur in spite of appropriate antituberculous therapy. The paradoxical response can occur as an intracranial tuberculoma, pleurisy, pericarditis and contralateral new parenchymal lesions. However, poor compliance with therapy, drug resistance, non-tuberculous mycobacterium, or another underlying condition as lung cancer should be ruled out before concluding that the treatment is the cause of the exacerbation. The case reports of paradoxical response have been mainly reported in adults, but extremely rare in children. We report a case of paradoxical response in which a new parenchymal lung lesion developed during antituberculous therapy in a 14-year-old female patient with tuberculous pleurisy. She experienced clinical improvement with steroid therapy in addition to antituberculous therapy.