PMID- 36567181
OWN - NLM
STAT- MEDLINE
DCOM- 20230223
LR  - 20230402
IS  - 1879-1972 (Electronic)
IS  - 1054-139X (Linking)
VI  - 72
IP  - 3
DP  - 2023 Mar
TI  - Clinical Worsening in an Adolescent With Pleural Tuberculosis.
PG  - 480-482
LID - S1054-139X(22)00786-8 [pii]
LID - 10.1016/j.jadohealth.2022.11.013 [doi]
AB  - A 17-year-old previously healthy female presented with unilateral chest pain and 
      dyspnea. Chest radiographs demonstrated a unilateral pleural effusion and 
      pneumonia. Pleural fluid bacterial cultures were negative; acid-fast cultures 
      grew Mycobacterium tuberculosis. Two months after starting appropriate therapy, 
      she had a recrudescence of symptoms and reaccumulation of the pleural fluid. Her 
      tuberculosis antibiotic regimen was expanded, the effusion drained, and systemic 
      corticosteroids initiated, resulting in rapid clinical improvement. Cultures of 
      the second pleural fluid collection were negative. Her clinical deterioration was 
      due to immune reconstitution inflammatory syndrome (IRIS). IRIS can be seen 
      within the first several months of starting tuberculosis therapy and can result 
      in paradoxical worsening of symptoms or radiographic findings in adolescents who 
      are on the appropriate therapy. IRIS is a diagnosis of exclusion after drug 
      resistance and medication malabsorption, intolerance, and nonadherence are 
      excluded. Therapy includes nonsteroidal anti-inflammatory agents for milder 
      reactions and systemic corticosteroids for more severe IRIS cases.
CI  - Copyright (c) 2022 Society for Adolescent Health and Medicine. Published by 
      Elsevier Inc. All rights reserved.
FAU - Cruz, Andrea T
AU  - Cruz AT
AD  - Department of Pediatrics, Baylor College of Medicine, Houston, Texas. Electronic 
      address: acruz@bcm.edu.
FAU - Starke, Jeffrey R
AU  - Starke JR
AD  - Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
LA  - eng
PT  - Journal Article
DEP - 20221223
PL  - United States
TA  - J Adolesc Health
JT  - The Journal of adolescent health : official publication of the Society for 
      Adolescent Medicine
JID - 9102136
RN  - 0 (Adrenal Cortex Hormones)
RN  - 0 (Anti-Bacterial Agents)
SB  - IM
MH  - Humans
MH  - Female
MH  - Adolescent
MH  - *Tuberculosis, Pleural/drug therapy
MH  - *Mycobacterium tuberculosis
MH  - Adrenal Cortex Hormones/therapeutic use
MH  - Anti-Bacterial Agents/therapeutic use
MH  - *Immune Reconstitution Inflammatory Syndrome/drug therapy
OTO - NOTNLM
OT  - Immune reconstitution inflammatory syndrome
OT  - Paradoxical worsening
OT  - Pleural tuberculosis
EDAT- 2022/12/26 06:00
MHDA- 2023/02/25 06:00
CRDT- 2022/12/25 21:54
PHST- 2022/07/23 00:00 [received]
PHST- 2022/11/12 00:00 [revised]
PHST- 2022/11/16 00:00 [accepted]
PHST- 2022/12/26 06:00 [pubmed]
PHST- 2023/02/25 06:00 [medline]
PHST- 2022/12/25 21:54 [entrez]
AID - S1054-139X(22)00786-8 [pii]
AID - 10.1016/j.jadohealth.2022.11.013 [doi]
PST - ppublish
SO  - J Adolesc Health. 2023 Mar;72(3):480-482. doi: 10.1016/j.jadohealth.2022.11.013. 
      Epub 2022 Dec 23.