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Indian J Med Microbiol. 2019 Jul-Sep;37(3):450-453. doi: 10.4103/ijmm.IJMM_18_242.

Paradoxical upgradation response in non-HIV tuberculosis: Report of two cases.

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Department of Internal Medicine, Batra Hospital and Medical Research Centre, New Delhi, India.


A paradoxical upgradation response in tuberculosis (TB) is defined as the worsening of a pre-existing tubercular lesion or the appearance of a new lesion in a patient whose clinical symptoms initially improved with anti-TB treatment. A paradoxical response is common in HIV patients in the form of immune reconstitution inflammatory syndrome. A similar kind of response can also be seen in immunocompetent patients. Here, we present two cases of non-HIV TB who initially improved with antitubercular therapy (ATT) but worsened thereafter. After excluding possibilities such as multidrug-resistant TB, treatment failure or a superadded infection, a paradoxical upgradation response was diagnosed. Both the cases improved after treatment with corticosteroids in addition to ATT.


Antitubercular therapy; non-HIV; paradoxical reaction; paradoxical response

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