{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:15:02Z","timestamp":1760058902897,"version":"build-2065373602"},"reference-count":14,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T00:00:00Z","timestamp":1746144000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infectious Disease Reports"],"abstract":"<jats:p>Background: The appearance of new clinical manifestations (for example, subcutaneous or skin abscesses) during anti-tuberculosis treatment is generally indicative of therapeutic failure. The cause of therapeutic failure may be the presence of a drug-resistant Mycobacterium infection or to the failure to achieve a sufficient concentration of the drugs in the bloodstream. Case report: Here, we report the case of a 25-year-old man suffering from tuberculosis infection with lymph-node and pulmonary involvement and an atypical response to specific therapy. Two weeks after starting four-drug antitubercular treatment, the patient began to experience fever, pain and functional impotence in the left foot and ankle, with subsequent evidence of ankle and tarsal osteomyelitis. Four weeks after starting treatment, the patient presented with several widespread, painful subcutaneous abscesses on the trunk, back and right lower limb. Drainage was performed from the ankle and from one of the abscesses, and polymerase chain reaction (PCR) showed a positive result for M. tuberculosis in both samples, with the absence of resistance to drugs. Anti-tubercular medications were continued, with resolution of the pulmonary and bone involvement but with persistence of subcutaneous abscesses, although subsequent drainages showed the absence of mycobacterium tuberculosis. Conclusions: We describe an unusual presentation of paradoxical reaction in the form of osteomyelitis and subcutaneous abscesses in an immunocompetent TB patient, and we reported other similar cases of paradoxical reactions described in the literature in the last ten years, which demonstrate the importance of considering paradoxical reactions in patients who present with new or worsening signs and symptoms after starting tuberculosis treatment.<\/jats:p>","DOI":"10.3390\/idr17030046","type":"journal-article","created":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T08:28:11Z","timestamp":1746174491000},"page":"46","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Appearance of Osteomyelitis of the Foot and Disseminated Subcutaneous Abscesses During Treatment for Disseminated Tuberculosis Infection in an Immunocompetent Patient: Case Presentation of a Paradoxical Reaction and Literature Review"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6845-3554","authenticated-orcid":false,"given":"Luca","family":"Santilli","sequence":"first","affiliation":[{"name":"Unit of Infection Diseases, San Salvatore Hospital, Azienda Sanitaria Territoriale Pesaro e Urbino, CAP 61121 Pesaro, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benedetta","family":"Canovari","sequence":"additional","affiliation":[{"name":"Unit of Infection Diseases, San Salvatore Hospital, Azienda Sanitaria Territoriale Pesaro e Urbino, CAP 61121 Pesaro, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Balducci","sequence":"additional","affiliation":[{"name":"Unit of Infection Diseases, San Salvatore Hospital, Azienda Sanitaria Territoriale Pesaro e Urbino, CAP 61121 Pesaro, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Ginevri","sequence":"additional","affiliation":[{"name":"Unit of Infection Diseases, San Salvatore Hospital, Azienda Sanitaria Territoriale Pesaro e Urbino, CAP 61121 Pesaro, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monia","family":"Maracci","sequence":"additional","affiliation":[{"name":"Unit of Infection Diseases, San Salvatore Hospital, Azienda Sanitaria Territoriale Pesaro e Urbino, CAP 61121 Pesaro, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Polenta","sequence":"additional","affiliation":[{"name":"Unit of Infection Diseases, San Salvatore Hospital, Azienda Sanitaria Territoriale Pesaro e Urbino, CAP 61121 Pesaro, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norma","family":"Anzalone","sequence":"additional","affiliation":[{"name":"Unit of Infection Diseases, San Salvatore Hospital, Azienda Sanitaria Territoriale Pesaro e Urbino, CAP 61121 Pesaro, Italy"},{"name":"Department of Biomedical Sciences and Public Health, Universit\u00e0 Politecnica delle Marche, CAP 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucia","family":"Franca","sequence":"additional","affiliation":[{"name":"Unit of Infection Diseases, San Salvatore Hospital, Azienda Sanitaria Territoriale Pesaro e Urbino, CAP 61121 Pesaro, Italy"},{"name":"Department of Biomedical Sciences and Public Health, Universit\u00e0 Politecnica delle Marche, CAP 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beatrice","family":"Mariotti","sequence":"additional","affiliation":[{"name":"Unit of Infection Diseases, San Salvatore Hospital, Azienda Sanitaria Territoriale Pesaro e Urbino, CAP 61121 Pesaro, Italy"},{"name":"Department of Biomedical Sciences and Public Health, Universit\u00e0 Politecnica delle Marche, CAP 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucia","family":"Sterza","sequence":"additional","affiliation":[{"name":"Unit of Infection Diseases, San Salvatore Hospital, Azienda Sanitaria Territoriale Pesaro e Urbino, CAP 61121 Pesaro, Italy"},{"name":"Department of Biomedical Sciences and Public Health, Universit\u00e0 Politecnica delle Marche, CAP 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Barchiesi","sequence":"additional","affiliation":[{"name":"Unit of Infection Diseases, San Salvatore Hospital, Azienda Sanitaria Territoriale Pesaro e Urbino, CAP 61121 Pesaro, Italy"},{"name":"Department of Biomedical Sciences and Public Health, Universit\u00e0 Politecnica delle Marche, CAP 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.revmed.2024.01.008","article-title":"R\u00e9action paradoxale tuberculeuse [Paradoxical tuberculosis reaction]","volume":"45","author":"Azoulay","year":"2024","journal-title":"Rev. Med. Interne"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2083","DOI":"10.1007\/s15010-024-02310-0","article-title":"Post-tuberculosis treatment paradoxical reactions","volume":"52","author":"Hermans","year":"2024","journal-title":"Infection"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1007\/s15010-020-01430-7","article-title":"Corticosteroid therapy for the management of paradoxical inflammatory reaction in patients with pulmonary tuberculosis","volume":"48","author":"Done","year":"2020","journal-title":"Infection"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.2217\/fmb.15.9","article-title":"Paradoxical TB-IRIS in HIV-infected adults: A systematic review and meta-analysis","volume":"10","author":"Namale","year":"2015","journal-title":"Future Microbiol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Alharbi, A., Aljahdali, A., Ahamed, M.F., and Almarhabi, H. (2024). Left hand abscess as a paradoxical reaction during treatment of disseminated tuberculosis in immunocompetent patient: Case report and review of literature. BMC Infect. Dis., 24.","DOI":"10.1186\/s12879-024-10077-w"},{"key":"ref_6","first-page":"e50596","article-title":"Spectacular Improvement of Paradoxical Reaction in Tuberculosis after Tumor Necrosis Factor-Alpha Antagonist Therapy","volume":"15","author":"Samad","year":"2023","journal-title":"Cureus"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e20012","DOI":"10.1097\/MD.0000000000020012","article-title":"Vertebral tuberculosis as a paradoxical reaction to the treatment of pulmonary and meningeal tuberculosis in an immunocompetent patient: A case report","volume":"99","author":"Lacerda","year":"2020","journal-title":"Medicine"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"173","DOI":"10.11604\/pamj.2019.32.173.17893","article-title":"Tuberculose intestinale r\u00e9v\u00e9l\u00e9e par une occlusion intestinale aig\u00fce au cours d\u2019une r\u00e9action paradoxale au traitement anti-tuberculeux chez un patient immunocomp\u00e9tent: \u00c0 propos d\u2019un cas et revue de la litt\u00e9rature [Intestinal tuberculosis revealed by acute bowel obstruction during paradoxical reaction to antituberculosis treatment in an immunocompetent patient: About a case and literature review]","volume":"32","author":"Shinga","year":"2019","journal-title":"Pan. Afr. Med. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"450","DOI":"10.4103\/ijmm.IJMM_18_242","article-title":"Paradoxical upgradation response in non-HIV tuberculosis: Report of two cases","volume":"37","author":"Kabra","year":"2019","journal-title":"Indian J. Med. Microbiol."},{"key":"ref_10","first-page":"388","article-title":"Paradoxical Reaction in an Immunocompetent Internal Medicine Resident Suffering from Tubercular Lymphadenitis","volume":"7","author":"Neki","year":"2017","journal-title":"Int. J. Health Sci. Res."},{"key":"ref_11","first-page":"DD01","article-title":"Treatment paradox in musculo-skeletal tuberculosis in an immunocompetent adult male; a case report from a tertiary care hospital","volume":"9","author":"Chaskar","year":"2015","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1136\/thx.2003.019224","article-title":"Paradoxical reactions during tuberculosis treatment in patients with and without HIV co-infection","volume":"59","author":"Breen","year":"2004","journal-title":"Thorax"},{"key":"ref_13","first-page":"2625","article-title":"Paradoxical reaction in peripheral lymph node tuberculosis: A review for its prevalence, clinical characteristics, and possible treatment","volume":"94","author":"Rai","year":"2023","journal-title":"Monaldi Arch. Chest Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.ijid.2016.08.009","article-title":"Paradoxical reaction in immunocompetent children with tuberculosis","volume":"51","year":"2016","journal-title":"Int. J. Infect. Dis."}],"container-title":["Infectious Disease Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2036-7449\/17\/3\/46\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:26:30Z","timestamp":1760030790000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2036-7449\/17\/3\/46"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,2]]},"references-count":14,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["idr17030046"],"URL":"https:\/\/doi.org\/10.3390\/idr17030046","relation":{},"ISSN":["2036-7449"],"issn-type":[{"type":"electronic","value":"2036-7449"}],"subject":[],"published":{"date-parts":[[2025,5,2]]}}}