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TB-IRIS — SCE Infectious Diseases MCQ

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HardHIV MedicineTB-IRISSCE Infectious Diseases

A patient treated for tuberculosis lymphadenitis starts ART and two weeks later develops fever, enlarging nodes and new inflammatory infiltrates. Adherence is good and resistance and new infection are being excluded. What is the most likely diagnosis?

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Correct answer: C — Paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome

The best answer is “Paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome”. The temporal relationship and inflammatory worsening of known treated TB support paradoxical TB-IRIS; treatment usually continues while clinicians exclude resistance, non-adherence, toxicity and alternative infection. BHIVA guidance governs investigation and treatment of HIV-associated disease and supports standard specialist care when HIV is virologically controlled. NICE specifies UK testing, latent-infection treatment and drug-susceptible tuberculosis regimens.

Reference: BHIVA clinical guidelines: https://bhiva.org/clinical-guidelines/ NICE NG33: tuberculosis: https://www.nice.org.uk/guidance/ng33/chapter/Recommendations