• Cláudia Elizabeth Volpe-Chaves, Mara Luci Gonçalves Galiz Lacerda, Suse Barbosa Castilho, Simone Sousa Oliveira Fonseca, Bruna Abdul Ahad Saad, Caroline Franciscato, Tiago Kojun Tibana, Thiago Franchi Nunes, James Venturini, Sandra Maria do Valle Leone de Oliveira, and Anamaria Mello Miranda Paniago.
• Graduate Program in Infectious and Parasitic Diseases of Federal University of Mato Grosso do Sul.
• Medicine (Baltimore). 2020 May 22; 99 (21): e20012e20012.

IntroductionParadoxical reaction in tuberculosis (TB) is defined as the reappearance of general symptoms, aggravation of pre-existing diseases, or appearance of new lesions despite adequate anti-TB therapy. It may result from the hyperactivity of the immune response, resulting in an intense inflammation. There are few cases of vertebral TB reported as paradoxical reaction, mainly among immunocompetents patients.Patient ConcernsWe describe a male immunocompetent patient with confirmed pulmonary and meningeal TB. He was readmitted after 60 days of adequate treatment, with vertebral TB and paravertebral abscess, despite clinical improvement of the other locations. We defined as an uncommon case of a paradoxical reaction, confirmed by nuclear magnetic resonance and molecular rapid test for TB.DiagnosisMycobacterium tuberculosis (MTB) was detected in cerebrospinal fluid by molecular rapid test (Gene Xpert MTB/ rifampicina method). Sputum research and culture were positive for the same agent. Lumbosacral spine nuclear magnetic resonance revealed bone destruction from T8 to T11, and a paravertebral collection was found. Gene Xpert MTB/rifampicina and culture were positive for M tuberculosis in the drained material of the paravertebral abscess.InterventionsThe paravertebral abscess was drainage by tomography-guided. Treatment with 4 anti-TB drugs was extended for 60 days and 2 anti-TB drugs was maintained for 10 months. There was a complete clinical improvement.OutcomeAfter draining the paravertebral abscess, the patient progressively improved and was discharged for outpatient follow-up. He was on antituberculous drugs for 1 year; subsequently, complete resolution of the infection was reported.ConclusionParadoxical reaction may be a difficult diagnosis in immunocompetent patient. Vertebral TB as a paradoxical reaction is an uncommon presentation. Therapeutic failure or resistance to treatment should be ruled out to confirm the diagnosis of paradoxical reaction.

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