[Unmasking immune reconstitution inflammatory syndrome (IRIS) in XDR-TB-HIV coinfection: a case report]

A patient with untreated chronic HIV infection was admitted for further treatment of acute pulmonary embolism with hemodynamic compromise. In the presence of constitutional symptoms (fever, night sweats, weight loss), no evidence of malignancy and/or opportunistic infection was found. Abdominal ultrasound revealed small amounts of ascites without evidence of spontaneous bacterial peritonitis (SBP) as well as underlying steatohepatitis with hypoproteinemia and right heart failure. Antiretroviral therapy (ART) was initiated. Fulminant peritonitis developed, which did not respond to broad anti-infective therapy. Furthermore, progressive respiratory failure developed. An immune reconstitution inflammatory syndrome (IRIS) was considered as a possibility and, finally, peritoneal as well as pulmonary tuberculosis (TB) were diagnosed. SUMMARY: In case of unexplained inflammatory response following the initiation of ART, IRIS due to tuberculosis should be considered in the differential diagnosis and treated at an early stage. Before initiating ART, opportunistic infections, in particular TB if clinically suspected, must be ruled out by biopsy if necessary.