Paradoxical Worsening of Extrapulmonary Tuberculosis in a Pediatric Case While on ATT: Diagnostic and Therapeutic Challenges

Paradoxical reactions are inflammatory responses that occur during effective anti-tubercular therapy (ATT), typically presenting as new or worsening lesions after an initial period of clinical improvement. These reactions are more commonly seen in extrapulmonary tuberculosis (EPTB), but remain underdiagnosed, especially in children. The radiologic progression without clinical deterioration was diagnosed as a paradoxical reaction. While on ATT, a 13-year-old immunocompetent kid showed signs of progressive abdominal extrapulmonary tuberculosis. Despite radiographic progression, the patient's clinical stability permitted routine care to continue without the need for surgery or the escalation to second-line medications. The significance of identifying paradoxical deterioration in paediatric EPTB is highlighted by this specific case, which should not be misconstrued as treatment failure or medication resistance.