(CR31) Tuberculosis Immune Reconstitution Inflammatory Syndrome (TB-IRIS) in an Immunocompetent Child: A Case Report

Introduction:

Tuberculosis – immune reconstitution inflammatory syndrome (TB-IRIS) is a paradoxical worsening or recurring of pre-existing tuberculous lesions, or development of new lesions in patients on effective antituberculosis treatment.

Case Report/Description:

A 13-year-old girl with disseminated TB developed neurological symptoms and behavioural changes. Initial CT and MRI brain showed extensive intracranial tuberculomas, leptomeningeal lesions and intraspinal involvement with resultant communicating hydrocephalus. Despite continuation of antiTB treatment, patient developed worsening neurological symptoms. A repeat MRI Brain showed worsening intracranial lesions and extensive vasogenic oedema, raising the suspicion of an alternative diagnosis thus necessitating a brain tissue biopsy. However, histopathological result was negative for tumour. Subsequently TB-IRIS was suspected and patient showed clinical as well as radiological improvement after initiation of steroid therapy.

Discussion/Conclusion:

TB-IRIS may occur in HIV-infected or uninfected patients, during or after completion of anti-TB therapy. There is no specific test to confirm or rule out this diagnosis. Unfortunately, this paradoxical worsening may be misinterpreted as superimposed infections, treatment failure following inadequate anti-TB  treatment, drug-resistant TB or TB relapse. TB-IRIS should be considered in TB patients, including non-HIV infected patients, with worsening symptoms despite receiving optimal anti -TB therapy.