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Paradoxical reaction manifesting as new pulmonary nodules emerging synchronously and sequentially in the lung ipsilateral to pleural effusion in an HIV-negative patient with tuberculous pleuritis: A case report

Year: 2026

Type: article

Abstract: . This reaction can develop during or after standard antituberculous therapy (ATT), more frequently in HIV-positive individuals and occasionally in HIV-negative ones. Pulmonary nodules are a rare presentation of PR, which is easily misdiagnosed as pulmonary malignancy, fungal infection and other thoracic diseases. Herein we present a 19-year-old HIV-negative young male with right tuberculous pleuritis who underwent standardized ATT. Three months into treatment, routine chest computed tomography (CT) detected multiple new pulmonary nodules on the affected side. CT-guided percutaneous lung biopsy confirmed caseating granulomatous inflammation. After ruling out other potential etiologies, the patient was diagnosed with a tuberculous paradoxical reaction. The original ATT regimen was maintained. During follow-up, three pre-existing nodules in the right lung gradually regressed, while one enlarged and an additional nodule developed. The patient was asymptomatic and declined further examinations, and the initial ATT regimen continued. He eventually finished the full 12-month ATT course. Nine months after treatment completion, the majority of lesions resolved nearly completely. Clinicians should be highly alert to paradoxical reaction when new pulmonary nodules emerge synchronously or asynchronously in the ipsilateral lung with pleural effusion among tuberculous pleurisy patients on ATT. The diagnosis depends on the exclusion of alternative causes. For asymptomatic patients, the original ATT regimen should be continued. Long-term regular follow-up is essential.

Source: Respiratory Medicine Case Reports

DOI: 10.1016/j.rmcr.2026.102527

Authors: Yujiao Xiong, Yongqiang Bao, Bei Jia

Institution: The Affiliated Yongchuan Hospital of Chongqing Medical University

Language: English

Topic: Tuberculosis Research and Epidemiology

Subfield: Infectious Diseases

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,200