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Corticosteroids for TB Paradoxical Reaction — SCE Infectious Diseases MCQ

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ModerateTuberculosisCorticosteroids for TB Paradoxical ReactionSCE Infectious Diseases

A 50-year-old man with TB develops a paradoxical reaction — cervical lymph nodes enlarge and a new draining sinus forms during week 8 of effective anti-TB therapy. CRP has improved. What role do corticosteroids play?

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Correct answer: C — Prednisolone 40 mg/day tapered over 4–6 weeks may be used for severe paradoxical reactions — corticosteroids reduce the inflammatory component; TB treatment should continue unchanged

Severe paradoxical reactions (large/compressive lymphadenopathy, systemic symptoms, draining sinuses causing significant morbidity) may be treated with corticosteroids: Prednisolone 40 mg/day for 2 weeks then taper over 4–6 weeks. Anti-TB therapy should continue UNCHANGED — the paradoxical reaction is NOT treatment failure. Mild reactions (asymptomatic lymph node enlargement with stable CRP) are managed expectantly without corticosteroids. Aspiration of fluctuant nodes through intact skin prevents chronic sinus formation.

Reference: NICE NG33 2016 – TB; BTS 2024 – Paradoxical reactions