Mehta Aadit, Pant Alok
The Oakridge School, 5900 Pioneer Pkwy, Arlington, TX, 76013, USA.
, Shreveport, LA, 71103, USA.
J Med Case Rep. 2025 Mar 3;19(1):93. doi: 10.1186/s13256-025-05081-w.
Tuberculosis immune reconstitution inflammatory syndrome is an uncommon condition caused by excessive immune response against Mycobacterium tuberculosis. We report on a case which may have been precipitated by coronavirus disease messenger ribonucleic acid vaccine booster.
A 47-year old Indian man developed reactivation tuberculosis in the cervical lymph nodes in the setting of immune suppression caused by tumor necrosis factor inhibitor adalimumab. The symptoms improved with starting antituberculous therapy, but 5 days after receiving a coronavirus disease booster messenger ribonucleic acid vaccine, he had recurrence of severe constitutional symptoms. After a detailed evaluation, he was diagnosed with immune reconstitution inflammatory syndrome and was successfully treated with high-dose steroid therapy, which was weaned off over several weeks.
Immune reconstitution inflammatory syndrome should be considered as a differential in patients who develop paradoxical worsening of symptoms with antitubercular therapy in the setting of immune reconstitution. Hyperactive immune response after infection or messenger ribonucleic acid vaccine booster may have contributed to the development of immune reconstitution inflammatory syndrome syndrome in this patient.
结核病免疫重建炎症综合征是一种由针对结核分枝杆菌的过度免疫反应引起的罕见病症。我们报告了一例可能由冠状病毒病信使核糖核酸疫苗加强针诱发的病例。
一名47岁的印度男子在因肿瘤坏死因子抑制剂阿达木单抗导致免疫抑制的情况下，颈部淋巴结发生了复发性结核病。开始抗结核治疗后症状有所改善，但在接种冠状病毒病加强信使核糖核酸疫苗5天后，他再次出现严重的全身症状。经过详细评估，他被诊断为免疫重建炎症综合征，并通过高剂量类固醇疗法成功治疗，该疗法在数周内逐渐减量。
在免疫重建背景下接受抗结核治疗后症状出现反常恶化的患者中，应将免疫重建炎症综合征视为鉴别诊断之一。感染或信使核糖核酸疫苗加强针后的免疫反应亢进可能促成了该患者免疫重建炎症综合征的发生。
