An unusual cause of chest pain: Mycobacterium avium complex and the immune reconstitution inflammatory syndrome.

The HIV-associated immune reconstitution inflammatory syndrome usually manifests as new infections or worsening of pre-existing infections during the first few months of initiating anti-retroviral therapy. It is commonly associated with local or systemic inflammation, presumably due to rapid reconstitution of host immune system. Here we describe a unique case of the immune reconstitution inflammatory syndrome presenting as acute pericarditis and pericardial effusion caused by mycobacterium avium complex. We also demonstrate that judicious use of steroids, along with pathogen specific antimicrobial therapy, can prevent local complications of the inflammatory response.