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These reactions are frequently observed in patients coinfected with human immunodeficiency virus (HIV) upon the initiation of antiretroviral therapy (ART). Herein, we present a unique case of a paradoxical reaction in a previously healthy 19-year-old female who started anti-tuberculosis treatment for disseminated tuberculosis. Four weeks after treatment initiation, she developed two new swollen masses in her left dorsum of the hand, accompanied by fever and new right submandibular painful lymphadenopathy, with worsening of the preexisting left lower neck lymph node. The patient underwent needle aspiration from her new skin abscess on the dorsum of her left hand, which revealed positive polymerase chain reaction (PCR) for <jats:italic>Mycobacterium tuberculosis<\/jats:italic>. Anti-tuberculosis treatment was continued, and the patient fully recovered. We described an unusual presentation of paradoxical reaction manifested by a skin abscess at a site distant from her primary disease in an immunocompetent TB patient, which demonstrated the importance of considering paradoxical reactions in HIV-negative patients who present with worsening signs and symptoms after initial improvement following treatment initiation.<\/jats:p>","DOI":"10.1186\/s12879-024-10077-w","type":"journal-article","created":{"date-parts":[[2024,10,21]],"date-time":"2024-10-21T08:02:44Z","timestamp":1729497764000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Left hand abscess as a paradoxical reaction during treatment of disseminated tuberculosis in immunocompetent patient: case report and review of literature"],"prefix":"10.1186","volume":"24","author":[{"given":"Aisha","family":"Alharbi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aseel","family":"Aljahdali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Firoze","family":"Ahamed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan","family":"Almarhabi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,10,21]]},"reference":[{"key":"10077_CR1","doi-asserted-by":"crossref","unstructured":"Volpe-Chaves CE, Lacerda MLGG, Castilho SB, Fonseca SSO, Saad BAA, Franciscato C, Paniago AMM. (2020). Vertebral tuberculosis as a paradoxical reaction to the treatment of pulmonary and meningeal tuberculosis in an immunocompetent patient: a case report. Medicine, 99(21).","DOI":"10.1097\/MD.0000000000020012"},{"issue":"6","key":"10077_CR2","doi-asserted-by":"publisher","first-page":"1077","DOI":"10.2217\/fmb.15.9","volume":"10","author":"P -Namale","year":"2015","unstructured":"Namale P, Abdullahi L, Fine S, Kamkuemah M, Wilkinson R, Meintjes G. Paradoxical tb-iris in hiv-infected adults: a systematic review and meta-analysis. Future Microbiol. 2015;10(6):1077\u201399. https:\/\/doi.org\/10.2217\/fmb.15.9.","journal-title":"Future Microbiol"},{"issue":"8","key":"10077_CR3","doi-asserted-by":"publisher","first-page":"704","DOI":"10.1136\/thx.2003.019224","volume":"59","author":"RAM -Breen","year":"2004","unstructured":"Breen RAM, Smith CJ, Bettinson H, Dart S, Bannister B, Johnson MA, Lipman MCI. Paradoxical reactions during tuberculosis treatment in patients with and without HIV co-infection. Thorax. 2004;59(8):704\u20137.","journal-title":"Thorax"},{"issue":"1","key":"10077_CR4","doi-asserted-by":"publisher","first-page":"97","DOI":"10.3109\/09273948.2014.943350","volume":"23","author":"T -Yilmaz","year":"2014","unstructured":"Yilmaz T, Sel\u00e7uk E, Polat N, Mutlu K. Choroidal tuberculoma showing paradoxical worsening in a patient with miliary tb. Ocul Immunol Inflamm. 2014;23(1):97\u20139. https:\/\/doi.org\/10.3109\/09273948.2014.943350.","journal-title":"Ocul Immunol Inflamm"},{"key":"10077_CR5","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1186\/s12879-016-1624-x","volume":"16","author":"T -Shinohara","year":"2016","unstructured":"Shinohara T, Kagawa K, Okano Y, et al. Disseminated tuberculosis after pregnancy progressed to paradoxical response to the treatment: report of two cases. 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The protection of the privacy of the patient and level of confidentiality were ensured.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The patients provided written informed consent for the clinical details and images reported in this study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Clinical trial number"}},{"value":"All the authors report no conflicts of interest.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interests"}},{"value":"The authors declare no competing interests.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1186"}}