Paradox radiologic progression despite appropriate antituberculosis therapy

In this study we report a HIV negative case who got worse paradoxically in the course of antituberculosis therapy. A 68-year old male patient applied with complaints of cough, chest pain, and weight loss. Chest computed tomography revealed an irregular nonhomogenous opacity involving the apical and posterior segments of superior lobe of right lung. At the end of the first month of therapy radiological lesions increased. There was no endobronchial lesion on bronchoscopy, and no acid-fast bacilli in bronchial lavage fluid. Therapy protocol was not changed but radiological lesions regressed gradually. In conclusion, temporary deteriorations can occur in previous pulmonary infiltrates in patients who are under appropriate antituberculosis therapy. The gold standard for monitorization is microbiological methods but not radiological ones. Comorbid conditions, drug reaction and treatment failure is important in the differential diagnosis.