Immune Reconstitution Inflammatory Syndrome – Kochs

Abstract

Immune Reconstitution Inflammatory Syndrome(IRIS) is defined as paradoxical deterioration in clinical status after Anti Retroviral Therapy(ART) initiation despite improved immune function due to inflammatory response against infectious agent, which may or may not be diagnosed at initiation of ART. Tuberculosis is most common opportunistic infection in HIV patients. Though it can present at any stage of HIV infection, it appears more commonly when CD4 count is around 350cells/microL. In advanced stages of AIDS, tuberculosis remains quiescent and may not present clinically or radiologically. With initiation of ART, tuberculosis may appear as IRIS. We report a case of tuberculosis presenting as IRIS in HIV-1 infected patient who had no previous history of mycobacterial infection. The patient was kept on ART with a baseline CD4+ count of 63 cells/microL. Ten days after initiation of ART patient had massive pericardial effusion leading to cardiac tamponade with pleural effusion and fever. His repeat CD4 count increased to 100 cells/mm 3 . On analysing pericardial and pleural effusions, a diagnosis of tuberculosis was made and patient was started on anti-tuberculosis therapy (ATT) along with ART and systemic steroids. Tuberculosis is commonest opportunistic infection presenting as IRIS.