Paradoxical psoas and subcutaneous abscesses developing on anti-tuberculous treatment: A case report and literature review

Tuberculosis (TB) is an infectious disease which has different clinical presentations. Paradoxical reaction (PR) is defined as the temporary aggravation of present TB lesions or the emergence of new lesions despite adequate anti-TB therapy. 1 , 2 Although the pathogenesis of this phenomenon is not fully elucidated, it is presumed to be a delayed-type hypersensitivity reaction to tuberculo-proteins. PR can be seen in different rates based on clinical forms of TB disease. 1 It is reported with the rate of 25% in TB lymphadenitis but lower rate in other forms of TB. 3 , 4 PR is very rare in spinal TB infection. 1 In this report, an immunocompetent patient who developed recurrent psoas and subcutaneous abscesses during the 10 th month of TB-treatment was described. Additionally, relevant literature was reviewed and extra-nodal paradoxical tuberculous abscesses in English were discussed among HIV-negative patients. To our knowledge, this is the largest paradoxical tuberculous abscesses ever reported.