Paradoxical reaction during treatment of spinal tuberculosis in an immunocompetent individual

Authors

  • Lívia Novaes Teixeira Instituto de Infectologia Emílio Ribas
  • Felipe Meirelles Doria Instituto de Infectologia Emílio Ribas
  • Leonardo Carrara Matsuura Instituto de Infectologia Emílio Ribas
  • Barbara Bastelli Instituto de Infectologia Emílio Ribas
  • Icaro Santos Oliveira Irmandade Santa Casa de Misericórdia de São Paulo
  • Taiana Cunha Ribeiro Irmandade Santa Casa de Misericórdia de São Paulo

DOI:

https://doi.org/10.5935/2764-734X.e20250461

Keywords:

Spinal Tuberculosis, Discitis, Antituberculosis Agents, Case Report

Abstract

Paradoxical reactions to the treatment of spinal tuberculosis in HIV-uninfected individuals, with clinical and radiological worsening, are rarely described in the literature. We report the case of a 26-year-old woman complaining of pain in the thoracic spine who had a previous history of coughing, night sweats, and weight loss. Magnetic resonance imaging of the thoracic spine showed discitis and incipient spinal cord compression. Despite the negative results of the etiological investigation, empirical treatment for tuberculosis was initiated based on clinical and radiological criteria. Despite adequate medication, the patient developed alterations in physical examination suggestive of spinal cord compression, which was also observed on new imaging findings of worsening bone involvement, deformity of the vertebral bodies, and increased adjacent fluid collections. Consequently, a surgical approach with resection of the posterior vertebral element and arthrodesis was necessary, and the diagnosis was confirmed by a rapid test for tuberculosis using a sample taken intraoperatively. The patient progressed satisfactorily without sequelae during the drug treatment period, which did not include corticosteroids.

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Published

2025-08-01

How to Cite

Teixeira, L. N., Doria, F. M., Matsuura, L. C., Bastelli, B., Oliveira, I. S., & Ribeiro, T. C. (2025). Paradoxical reaction during treatment of spinal tuberculosis in an immunocompetent individual. Infections in Evidence, 4, e20250461. https://doi.org/10.5935/2764-734X.e20250461

Issue

Vol. 4 (2025)

Section

Case Reports

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