Paradoxical responses to modified, all-oral shorter treatment of tuberculosis in non-immunocompromised patients: Cases from Armenia

BackgroundThe previous publications presented paradoxical responses to anti-TB treatment in non-immunocompromised patients. Treatment for extra-pulmonary tuberculosis was associated with the majority of these responses.ObjectivesIn this paper, we present three cases of paradoxical radiological worsening in the HIV-negative patients receiving new modified, all-oral shorter regimens for pulmonary tuberculosis.MethodsThe treatment effectiveness was assessed based on the radiological and bacteriological examinations. Each of the three patients was adherent to treatment.ResultsAnti-TB therapy was effective in all of the cases, evidenced by bacteriological response. After initiation of treatment, the chest X-rays showed increased infiltration in the lungs. The patients continued treatment without adjustments of the shorter regimens. The following chest X-rays revealed positive dynamics. Despite the lack of specific therapeutic interventions to address radiological deterioration, the shorter treatment courses were successful. This means that radiological worsening detected in the middle of shorter treatment does not always indicate that anti-TB chemotherapy is ineffective.ConclusionParadoxical deterioration of chest X-ray findings may happen in HIV-negative patients receiving shorter regimens for rifampicin-resistant pulmonary tuberculosis but this worsening is not a reliable indicator for treatment outcome prediction. Additional therapeutic interventions or modifications of the chemotherapy regimens are not always necessary.