Acute lymphoid leukemia and pott mal: Paradoxical response to antitbc treatment

Leucemia linfoide aguda y mal de pott: Respuesta paradójica al tratamiento antitbc

A 58-year-old man with a diagnosis of acute lymphoid leukemia who underwent transplantation of peripheral blood progenitors from an intrafamilial donor. It required immunosuppressive management due to the presence of acute and chronic graft versus host disease. He consulted for severe lumbar pain and in the examinations were found compatible lesions with spondylodiscitis L4-L5 and paravertebral collections. With suspicion of tuberculosis, empirical treatment was started, the initial clinical evolution was torpid due to persistent symptoms and progressive neurological compromise, for which the presence of atypical vs resistant mycobacteria was suspected. Isolation of Mycobacterium tuberculosis susceptible to the established therapy was achieved. TBC treatment scheme with clinical evolution to improvement was continued. It was interpreted as a paradoxical reaction to the therapy, but with the presence of a renal lesion in which a relapse of the haematological disease was confirmed. Abbreviations: TB, tuberculosis.

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