{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T18:34:05Z","timestamp":1789842845672,"version":"4.0.1"},"reference-count":9,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T00:00:00Z","timestamp":1739491200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>We describe the case of a 67-year-old man with lung cancer, who developed pulmonary tuberculosis (TB) following chemotherapy and subsequently exhibited a paradoxical reaction on positron emission tomography\/computed tomography (PET\/CT) after initiating antituberculosis therapy. While pulmonary consolidations improved with antituberculosis treatment, newly detected hypermetabolic mediastinal lymph nodes appeared on PET\/CT. Based on the clinical course, we provisionally concluded that the mediastinal lymphadenopathy represented a paradoxical reaction. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) confirmed the diagnosis of TB. Clinicians added steroids and continued the antituberculosis medication, and follow-up PET\/CT showed complete resolution of these lesions. This case highlights the importance of recognizing paradoxical reactions to antituberculosis therapy, when restaging PET\/CT reveals divergent findings, with some tumor foci responding and other lesions appearing to be progressing.<\/jats:p>","DOI":"10.3390\/diagnostics15040472","type":"journal-article","created":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T11:14:41Z","timestamp":1739531681000},"page":"472","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Paradoxical Reaction to Antituberculosis Therapy Mimicking Tumor Progression in Lung Cancer Patient"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0865-1425","authenticated-orcid":false,"given":"Eunkyoung","family":"Choi","sequence":"first","affiliation":[{"name":"Department of Radiology, Incheon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong-An","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Radiology, Incheon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ju Sang","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06951, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinkyoung","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Radiology, Incheon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.ijid.2014.12.030","article-title":"Paradoxical reactions and immune reconstitution inflammatory syndrome in tuberculosis","volume":"32","author":"Bell","year":"2015","journal-title":"Int. J. Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1016\/j.jiac.2016.03.012","article-title":"Paradoxical reaction to antituberculosis therapy after 6 months of treatment for pulmonary tuberculosis: A case report","volume":"22","author":"Okazaki","year":"2016","journal-title":"J. Infect. Chemother."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Brown, C.S., Smith, C.J., Breen, R.A., Ormerod, L.P., Mittal, R., Fisk, M., Milburn, H.J., Price, N.M., Bothamley, G.H., and Lipman, M.C. (2016). Determinants of treatment-related paradoxical reactions during anti-tuberculosis therapy: A case control study. BMC Infect. Dis., 16.","DOI":"10.1186\/s12879-016-1816-4"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Quinn, C.M., Poplin, V., Kasibante, J., Yuquimpo, K., Gakuru, J., Cresswell, F.V., and Bahr, N.C. (2020). Tuberculosis IRIS: Pathogenesis, Presentation, and Management across the Spectrum of Disease. Life, 10.","DOI":"10.3390\/life10110262"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.ijid.2016.10.025","article-title":"Paradoxical reaction associated with cervical lymph node tuberculosis: Predictive factors and therapeutic management","volume":"54","author":"Chahed","year":"2017","journal-title":"Int. J. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1097\/INF.0b013e3182846c4e","article-title":"Paradoxical reaction during tuberculosis treatment in immunocompetent children: Clinical spectrum and risk factors","volume":"32","author":"Olive","year":"2013","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1016\/j.jinf.2013.07.022","article-title":"Incidence and outcomes of paradoxical lymph node enlargement after anti-tuberculosis therapy in non-HIV patients","volume":"67","author":"Park","year":"2013","journal-title":"J. Infect."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.jiac.2018.06.016","article-title":"Paradoxical response in a patient with non-small cell lung cancer who received nivolumab followed by anti-Mycobacterium tuberculosis agents","volume":"25","author":"Takata","year":"2019","journal-title":"J. Infect. Chemother."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1148\/rg.2019180093","article-title":"Pitfalls of a Mixed Metabolic Response at PET\/CT","volume":"39","author":"Clark","year":"2019","journal-title":"Radiographics"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/4\/472\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:34:47Z","timestamp":1760027687000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/4\/472"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,14]]},"references-count":9,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["diagnostics15040472"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15040472","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,14]]}}}