The Indian Journal of Chest Diseases and Allied Sciences

Register      Login

VOLUME 66 , ISSUE 2 ( April-June, 2024 ) > List of Articles

CASE REPORT

Immune Reconstitution Inflammatory Syndrome: A Rare Cause of Pleural Effusion in Rifampicin Resistance Non-HIV TB Lymphadenitis Patient

Archana Malik, Pratyaksha Kumari, Sarthak Das, Mahesh B Vemuri, Saroj Tripathy

Keywords : Case report, Immune reconstitution inflammatory syndrome, Rifampicin resistance, TB immune reconstitution inflammatory syndrome, TB lymphadenitis

Citation Information : Malik A, Kumari P, Das S, Vemuri MB, Tripathy S. Immune Reconstitution Inflammatory Syndrome: A Rare Cause of Pleural Effusion in Rifampicin Resistance Non-HIV TB Lymphadenitis Patient. Indian J Chest Dis Allied Sci 2024; 66 (2):68-70.

DOI: 10.5005/jp-journals-11007-0118

License: CC BY-NC 4.0

Published Online: 10-07-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

The initiation of anti-tubercular treatment can trigger a pathological hyper-inflammatory response to viable or dead Mycobacterium tuberculosis, known as tuberculosis-immune reconstitution inflammatory syndrome (TB-IRIS). Tuberculosis immune reconstitution inflammatory syndrome has been extensively studied in HIV patients and is very rare in non-HIV patients. However, it can occur following corticosteroid withdrawal, discontinuation of anti-TNF therapy, or recovery from neutropenia in non-HIV patients. In non-HIV TB patients, TB-IRIS is particularly rare. The most common manifestation of TB-IRIS in cases of TB lymphadenitis is the development of new lymphadenopathy or the enlargement of pre-existing lymph nodes. Here, we report cases of rifampicin-resistant tubercular lymphadenitis with IRIS presenting with pleural effusion, which completely resolved following steroid therapy.


HTML PDF Share
  1. Lanzafame M, Vento S. Tuberculosis-immune reconstitution inflammatory syndrome. J Clin Tuberc Other Mycobact Dis 2016; 3:6–9. DOI: 10.1016/j.jctube.2016.03.002.
  2. Namale PE, Abdullahi LH, Fine S, et al. Paradoxical TB-IRIS in HIV-infected adults: A systematic review and meta-analysis. Future Microbiol 2015;10(6):1077–1099. DOI: 10.2217/fmb.15.9.
  3. Cheng VCC, Yam WC, Woo PCY, et al. Risk factors for development of paradoxical response during antituberculosis therapy in HIV-negative patients. Eur J Clin Microbiol Infect Dis 2003;22(10):597–602. DOI: 10.1007/s10096-003-0998-z.
  4. Cheng SL, Wang HC, Yang PC. Paradoxical response during anti-tuberculosis treatment in HIV-negative patients with pulmonary tuberculosis. Int J Tuberc Lung Dis 2007;11(12):1290–1295. PMID: 18034948.
  5. Aggarwal D, Bhardwaj M, Kumar A, et al. Immune reconstitution inflammatory syndrome in non-HIV patients with tuberculosis. A case series. Indian J Tuberc [Internet] 2020;67(1):143–147. DOI: 10.1016/j.ijtb.2019.02.018.
  6. Cevaal PM, Bekker LG, Hermans S. TB-IRIS pathogenesis and new strategies for intervention: Insights from related inflammatory disorders. Tuberculosis [Internet] 2019;118:101863. DOI: 10.1016/j.tube.2019.101863.
  7. Weber MR, Fehr JS, Kuhn FP, et al. Approach for tuberculosis-associated immune reconstitution inflammatory syndrome in an HIV-negative patient. BMJ Case Rep 2021;14(8):1–3. DOI: 10.1136/bcr-2019-232639.
  8. Shelburne SA, Hamill RJ, Rodriguez-Barradas MC, et al. Immune reconstitution inflammatory syndrome: Emergence of a unique syndrome during highly active antiretroviral therapy. Medicine (Baltimore) 2002;81(3):213–227. DOI: 10.1097/00005792-200205000-00005.
  9. Robertson J, Meier M, Wall J, et al. Immune reconstitution syndrome in HIV: Validating a case definition and identifying clinical predictors in persons initiating antiretroviral therapy. Clin Infect Dis 2006;42(11):1639–1646. DOI: 10.1086/503903.
  10. Worodria W, Menten J, Massinga-Loembe M, et al. Clinical spectrum, risk factors and outcome of immune reconstitution inflammatory syndrome in patients with tuberculosis-HIV coinfection. Antivir Ther 2012;17(5):841–848. DOI: 10.3851/IMP2108.
  11. Müller M, Wandel S, Colebunders R, et al. Incidence and lethality of immune reconstitution disease in HIV-infected patients starting antiretroviral therapy: Systematic review and meta-analysis. Lancet Infect Dis 2010;10(4):251–261. DOI: 10.1016/S1473-3099(10)70026-8.
  12. Bell LCK, Breen R, Miller RF, et al. Paradoxical reactions and immune reconstitution inflammatory syndrome in tuberculosis. Int J Infect Dis [Internet] 2015;32:39–45. DOI: 10.1016/j.ijid.2014.12.030.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.