The Dynamic Changes of Paradoxical IRIS of an AIDS Patient with Cytomegalovirus Encephalitis and Pulmonary Tuberculosis: A Case Report
Received Date: May 16, 2023 / Published Date: Jun 15, 2023
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
Citation: Song S, Jiang C, Gan D, Lu Y (2023) The Dynamic Changes of Paradoxical IRIS of an AIDS Patient with Cytomegalovirus Encephalitis and Pulmonary Tuberculosis: A Case Report. J Infect Dis Ther S3: 004. Doi: 10.4172/2332-0877.S3.004
Copyright: © 2023 Song S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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