Paradoxical Reaction to Antituberculosis Complicating Bacilifere Pulmonary Tuberculosis

Tuberculosis is still an endemic disease in many countries. Paradoxical reaction (PR) to antituberculosis drugs is a rare complication seen in patients on antituberculosis treatment. We report the case of a 58-year-old man who had been presenting for two months with a cough, signs of tuberculosis impregnation and uncalculated weight loss. Bacciloscopies were positive. We started the patient on antituberculosis treatment. One month later, the patient developed confusion and abdominal pain. The laboratory work-up and various radiological examinations (cerebral CT scan, cerebral MRI) revealed no abnormalities. Abdominal CT scan showed: a peritoneal effusion of low abundance with nodular infiltration of the fat of the great epiploon. After ruling out all other etiologies for the confusion, we retained the diagnosis of paradoxical reaction to anti-tuberculosis drugs. The patient received corticosteroid therapy with marked neurological improvement.