Immune reconstitution inflammatory syndrome in a patient with HIV presenting as severe mixed haemolytic anaemia

A patient with a delayed diagnosis of vertically transmitted HIV presented with a rare form of severe warm and cold (mixed) autoimmune haemolytic anaemia, six months after starting antiretroviral therapy. The CD4 count had responded rapidly to introduction of antiretroviral therapy, rising from 5 cells/µL to 93 cells/µL over the course of six months. The haemolysis was resistant to immunoglobulin therapy, eventually responding to corticosteroids. On careful scrutiny of the case, we found the features to be in keeping with immune reconstitution inflammatory syndrome; thorough investigations revealed no other trigger for haemolysis in this case.