ABSTRACT
HIV infection has changed the scenario of infectious disease. HIV-associated immunodeficiency resulted in a wide spectrum of new opportunistic infections. After introduction of antiretroviral therapy (ART), immune reconstitution inflammatory syndrome (IRIS) became an important challenge in management of 10% to 25% of the patients. Meta-analyses of IRIS from various reports published worldwide by Monika Muller et al described 12% IRIS incidence and 15.7% IRIS tuberculosis. Among IRIS tuberculosis, central nervous system involvement with IRIS tuberculous meningitis forms only 7%. Only 9 cases of tuberculous brain abscess is reported in patients with AIDS so far. The IRIS tuberculous brain abscess is very rare, and so far only 1 case is reported as a paradoxical reaction after ART initiation. Here, we report a case of recurrent IRIS tuberculosis meningitis and brain abscess.
Subject(s)
AIDS-Related Opportunistic Infections/immunology , AIDS-Related Opportunistic Infections/microbiology , Acquired Immunodeficiency Syndrome/immunology , HIV Infections/immunology , Immune Reconstitution Inflammatory Syndrome/microbiology , Tuberculoma, Intracranial/virology , AIDS-Related Opportunistic Infections/virology , Acquired Immunodeficiency Syndrome/microbiology , Adult , Anti-Retroviral Agents/therapeutic use , Antitubercular Agents/therapeutic use , HIV Infections/microbiology , Humans , Immune Reconstitution Inflammatory Syndrome/virology , Male , Tomography, X-Ray Computed , Tuberculoma, Intracranial/immunologyABSTRACT
HIV infection changed the scenario of infectious diseases. The pre-HAART (highly active antiretroviral therapy) era had resulted in new opportunistic infections. HIV and tuberculosis together had high mortality in countries with high prevalence of tuberculosis. Disseminated and extra pulmonary tuberculosis is common in PLHA (People Living with HIV and AIDS). IRIS (Immune Reconstitution Inflammatory Syndrome) after HAART is common (10% to 25%) in PLHA. Pott's spine is the most common presentation in PLHA of bone and skeletal system. IRIS tuberculosis, especially extra pulmonary tuberculosis, is the most common. In this case, we are presenting an IRIS disseminated tuberculosis in the form of acute osteomyelitis and mutilating dactylitis involving many joints of the fingers. Of 37 cases (9 from India) reported worldwide multiple dactylitis was never presented in the medical journals. This might be the first multiple dactylitis with extensive mutilation to the dactyls due to IRIS in a patient on ART.
