Abstract

Background: This study describes an AIDS patient with CNS tuberculosis and cytomegalovirus infection that experienced IRIS associated with cytomegalovirus encephalitis and PTB while receiving ART.

Case presentation: A 59-year-old male was referred to our hospital with a fever of unknown origin and paroxysmal cough as the main symptoms for three days. CSF examination revealed a cytomegaloviral load of 3.4 ×10³ copies/mL and a positive MTB recombination test. CSF gene X-pert MTB/RIF test revealed MTB infection without rifampicin resistance. Anti-tuberculosis treatment and anti-cytomegalovirus therapy were administered, improving clinical and laboratory abnormalities. ART was initiated 24 days after starting anti-tuberculosis treatment, with a baseline CD4⁺ T lymphocyte count of 70 cells/μL. Clinical symptoms reappeared on day 33 after starting ART. Paradoxical IRIS was considered the most likely diagnosis. After adding dexamethasone to continue antituberculosis and anti-CMV therapy, the patient’s symptoms disappeared, and imaging showed a reduction in scope. There was no recurrence of clinical symptoms during a two-year outpatient follow-up.

Conclusion: It is crucial to consider the emergence of multiple infections and the associated IRIS in AIDS. Once IRIS manifests, proper diagnosis and continual treatment are imperative for patient recovery.

Keywords: Immune reconstitution inflammatory syndrome; Cytomegalovirus; Tuberculosis; AIDS