Some patients with tuberculosis will deteriorate after antituberculous therapy is started.
Possible explanation: immune suppression secondary to tuberculosis
Clinical features:
(1) clinical diagnosis of tuberculosis
(2) initial improvement after antituberculous therapy started
(3) unexplained onset of clinical deterioration while receiving therapy
(4) improvement with corticosteroid therapy
Clinical deterioration may involve:
(1) development of new lesions
(2) radiologic worsening of lesions
(3) clinical worsening
Differential diagnosis:
(1) adverse drug reaction
(2) onset of another condition
(3) immune reconstitution inflammatory syndrome (IRIS) related to tuberculosis
(4) incorrect diagnosis of tuberculosis
(5) drug resistance with disease progression
(6) noncompliance with therapy
