Approach for tuberculosis-associated immune reconstitution inflammatory syndrome in an HIV-negative patient

A male refugee from the Middle East was diagnosed with pulmonary tuberculosis and Pott’s disease with paravertebral abscess. After starting the standard regimen, the sputum culture converted to negative and the patient’s general condition improved. Six weeks later, the patient presented with clinica...

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Bibliographic Details
Published in:BMJ case reports 2021-08, Vol.14 (8), p.e232639
Main Authors: Weber, Michèle Rebecca, Fehr, Jan Sven, Kuhn, Félix Pierre, Kaelin, Marisa Brigitta
Format: Article
Language:English
Subjects:
Abscesses
Antigens
Back pain
Bacterial infections
Case Report
Case reports
Drug resistance
HIV
Human immunodeficiency virus
Immune system
Infections
Inflammatory diseases
Medical diagnosis
Metabolism
Patients
Remission (Medicine)
Steroids
Tuberculosis
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Summary:A male refugee from the Middle East was diagnosed with pulmonary tuberculosis and Pott’s disease with paravertebral abscess. After starting the standard regimen, the sputum culture converted to negative and the patient’s general condition improved. Six weeks later, the patient presented with clinical worsening of known symptoms, new appearance of focal neurological deficits and progress of radiological features showing progression of the paravertebral abscess. Immune reconstitution inflammatory syndrome with Mycobacterium tuberculosis (TB-IRIS) was presumed, and treatment with high-dose steroids was started. Due to recurrent relapses while tapering, corticosteroids had to be given over a prolonged period. After treatment completion, the patient was in a good general condition, abscesses had decreased and neurological deficits were in complete remission. This case presents the rare manifestation of TB-IRIS in HIV-negative patients and its management in a high-income country.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2019-232639