Jaganmohan Deepasree, Chakkalakkoombil Sunitha V, Beena Anjana A, Krishnan Nagarajan
Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
Indian J Radiol Imaging. 2016 Oct-Dec;26(4):446-450. doi: 10.4103/0971-3026.195782.
Immune reconstitution inflammatory syndrome (IRIS) is an exaggerated immune response which can occur with various coinfections in human immunodeficiency virus (HIV) infected patients, of which the most commonly implicated in central nervous system (CNS)-IRIS are progressive multifocal leukoencephalopathy (PML), cryptococcosis, and tuberculosis (TB). TB-IRIS is a known complication of pulmonary TB or TB lymphadenitis coinfection in HIV infected patients who are on antituberculosis treatment (ATT) after the initiation of antiretroviral therapy (ART). However, development of IRIS in extrapulmonary TB such as CNS TB is very rare. Our case is that of an isolated CNS-TB-IRIS, presenting as increase in the size and perilesional edema of the ring enhancing lesions in the brain, which was observed in two sequential magnetic resonance imaging done over a period of 2 months in a retropositive patient who presented with clinical deterioration after commencement of ART. As prompt diagnosis was made and specific management aimed at IRIS was started without delay, the patient improved symptomatically.
免疫重建炎症综合征（IRIS）是一种过度的免疫反应，可发生于人类免疫缺陷病毒（HIV）感染患者的各种合并感染中，其中与中枢神经系统（CNS）-IRIS最常相关的是进行性多灶性白质脑病（PML）、隐球菌病和结核病（TB）。TB-IRIS是HIV感染患者在开始抗逆转录病毒治疗（ART）后接受抗结核治疗（ATT）时，肺结核或结核性淋巴结炎合并感染的一种已知并发症。然而，肺外结核如中枢神经系统结核发生IRIS的情况非常罕见。我们的病例是一例孤立的中枢神经系统-TB-IRIS，表现为脑部环形强化病灶的大小增加和病灶周围水肿，这在一名接受ART后出现临床恶化的回顾性患者中，于两个月内连续进行的两次磁共振成像中观察到。由于及时做出诊断并立即开始针对IRIS的具体治疗，患者症状得到改善。
