Figure 5.

Illustration of histological features representing a paradoxical reaction. a-d: Initial lesion before antibiotic treatment showing a sparse acute inflammatory reaction around necrotic fat and subcutaneous tissue (a) with high numbers of extracellular acid-fast bacilli (in pink) on Wade-Fite stain (b). After 8 weeks of antibiotic treatment showing a paradoxical reaction manifest by a dense inflammatory reaction including multinucleated giant cells (c) and no extracellular acid-fast bacilli seen with Wade-Fite stain (d).