Complexity of Mycobacterium avium complex immune reconstitution inflammatory syndrome (MAC-IRIS) in a patient with HIV

We report a case of Mycobacterium avium complex immune reconstitution inflammatory syndrome (MAC-IRIS) in a patient with HIV positive. Initial presentation was that of a purpuric purple macular rash in-keeping with Kaposi sarcoma as an AIDS defining illness. Three weeks following the initiation of a...

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Bibliographic Details
Published in:BMJ case reports 2021-09, Vol.14 (9), p.e241813
Main Authors: Xerri, Thelma, Borg, Janice, Casha, Ramon, Fsadni, Claudia
Format: Article
Language:English
Subjects:
Anorexia
Antiretroviral drugs
Biopsy
Case Report
Case reports
Disease prevention
Fever
HIV
Human immunodeficiency virus
Infections
Kaposis sarcoma
Lymphoma
Medical tests
Patients
Serology
Thorax
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Summary:We report a case of Mycobacterium avium complex immune reconstitution inflammatory syndrome (MAC-IRIS) in a patient with HIV positive. Initial presentation was that of a purpuric purple macular rash in-keeping with Kaposi sarcoma as an AIDS defining illness. Three weeks following the initiation of antiretroviral treatment (ART) she developed chest pain, dry cough and fever. A diagnosis of MAC was made through imaging and sputum cultures and appropriate treatment was initiated. Despite adequate management with evidence of good immunological and virological response, the patient represented with persistent symptoms. Repeat CT of the chest confirmed worsening lymphadenopathy with necrosis. Given these findings, a diagnosis of MAC-IRIS was made with resolution of fever after corticosteroids were initiated. This case highlights the importance of considering MAC as a cause of IRIS in severely immunosuppressed patients with HIV.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2021-241813