A unique paradoxical reaction to tuberculosis therapy: case report and brief review of the literature.

Extensive experience in the diagnosis and treatment of tuberculosis (TB) has led to treatment guidelines, which almost always result in progressive clinical improvement and cure in the compliant patient. Failure of a patient to respond as expected raises concerns of unexpected drug resistance, poor absorption, drug fever, or rarely an intense inflammatory reaction known as paradoxical reaction. Paradoxical reactions to anti-TB treatment are relatively rare in nonimmunocompromised individuals. Hepatic abscess is a very rare consequence of primary TB infection but has never been described as occurring as part of a paradoxical reaction. We present a case of a unique paradoxical reaction to initiation of TB treatment.

Valproate-induced hyperammonemic encephalopathy: a case report and brief review of the literature.

Almost 50 years after its discovery, valproic acid remains a mainstay in the treatment of epilepsy, both alone and in combination with other anticonvulsants. It is also associated with a hyperammonemic encephalopathy, when used in combination with other drugs. We present a case of valproate-induced hyperammonemic encephalopathy in a patient on multiple anticonvulsant and psychotropic medications. The patient presented with altered mental status and became progressively more obtunded and finally began to experience seizures. Her symptoms resolved with the discontinuation of valproic acid and with supportive care.