Three cases of localized pleural tuberculosis which looked exacerbated during antituberculous chemotherapy

: We reported three cases whose pleural tumorous shadows enlarged during the intensive chemotherapy for tuberculosis. The patients were 39 year-old female, 63 year-old female, and 22 year-old male. Their chest X-ray films on admission showed pleural effusion or infiltration, but no tumorous shadows. Eight to 16 weeks after starting the antituberculous therapy with INH, RFP and SM, new tumorous shadows appeared in the right chest wall (case 1, 3) or the left chest wall (case 2). The mass extracted from case 1 contained granuloma with caseous necrosis. The tumorous shadows on chest X-ray films in case 2 and 3 disappeared by continuous antituberculous therapy. We can not definitely conclude that the disease of these 3 cases were same diseases to be called either percostal tuberculosis, peripleural abscess or peripleuritis tuberculosa as observed in case 1. The phenomenon observed in case 2 and 3 is suspected to be caused by some allergic mechanism eg. Jarisch-Herxheimer reaction which is observed during the therapy for syphilis.