Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 19 , ISSUE 1 ( 2015 ) > List of Articles

CASE REPORT

Severe Mycobacterium tuberculosis-related immune reconstitution syndrome in an immunocompetent patient

Sujatha Chandrasekharan

Keywords : pneumothorax, respiratory failure, tuberculosis, Vitamin D,Immune reconstitution

Citation Information : Chandrasekharan S. Severe Mycobacterium tuberculosis-related immune reconstitution syndrome in an immunocompetent patient. Indian J Crit Care Med 2015; 19 (1):50-52.

DOI: 10.4103/0972-5229.148650

License: CC BY-ND 3.0

Published Online: 00-01-2015

Copyright Statement:  Copyright © 2015; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

We present a young immunocompetent male with diagnosed sputum culture-positive tuberculosis on intensive phase with observed daily four-drug antituberculosis therapy. He presented at 1-month of treatment with sequential bilateral pneumothoraces, increase in cavitation and consolidation and respiratory failure. Repeat smears for acid-fast bacilli had downgraded, and cultures were negative. Quantiferon-GOLD (initially negative) was now strongly positive. A diagnosis of possible immune reconstitution syndrome was considered and 0.25 mg/kg/day oral steroids administered. We also discuss an approach to differential diagnosis of a patient worsening on treatment for microbiologically confirmed tuberculosis in this manuscript.


PDF Share
  1. Martineau AR, Timms PM, Bothamley GH, Hanifa Y, Islam K, Claxton AP, et al. High-dose vitamin D(3) during intensive-phase antimicrobial treatment of pulmonary tuberculosis: A double-blind randomised controlled trial. Lancet 2011;377:242-50.
  2. Cerfolio RJ. Recent advances in the treatment of air leaks. Curr Opin Pulm Med 2005;11:319-23.
  3. 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;11:1290-5.
  4. Meintjes G, Lawn SD, Scano F, Maartens G, French MA, Worodria W, et al. Tuberculosis-associated immune reconstitution inflammatory syndrome: Case definitions for use in resource-limited settings. Lancet Infect Dis 2008;8:516-23.
  5. Novak RM, Richardson JT, Buchacz K, Chmiel JS, Durham MD, Palella FJ, et al. Immune reconstitution inflammatory syndrome: Incidence and implications for mortality. AIDS 2012;26:721-30.
  6. French MA, Price P, Stone SF. Immune restoration disease after antiretroviral therapy. AIDS 2004;18:1615-27.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.