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Sarcoid-IRIS Treatment — SCE Infectious Diseases MCQ

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ModerateHIV MedicineSarcoid-IRIS TreatmentSCE Infectious Diseases

A 40-year-old man with HIV on ART develops a rare complication: Immune Reconstitution Inflammatory Syndrome manifesting as sarcoidosis-like granulomatous disease. He has bilateral hilar lymphadenopathy and non-caseating granulomata on biopsy. All microbiological tests are negative. How should this be managed?

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Correct answer: E — Continue ART; treat as sarcoidosis with corticosteroids if symptomatic (cough, dyspnoea, hypercalcaemia); the condition may self-resolve with time

Sarcoid-like IRIS is a well-described non-infectious IRIS variant. Management: (1) CONTINUE ART — never stop, (2) exclude all infections (TB, Cryptococcus, Histoplasma — which can all cause granulomata), (3) if symptomatic, treat with systemic corticosteroids per standard sarcoidosis guidelines (Prednisolone 0.5 mg/kg, taper over months), (4) monitor for spontaneous resolution — many cases improve over 6–12 months without specific treatment. Methotrexate or Hydroxychloroquine may be considered for steroid-sparing in chronic cases.

Reference: BHIVA 2022 – IRIS; Lancet HIV 2019 – Sarcoidosis-IRIS