Immune mediated 'HAART' attack during treatment for tuberculosis. Highly active antiretroviral therapy.
Highly active antiretroviral therapy (HAART) suppresses viral replication and improves immune function. However the inflammatory component of immune restoration can have clinically deleterious effects on previously asymptomatic infections. We report the development of acute respiratory failure in a patient after the institution of HAART, following 2 months of appropriate therapy for pulmonary tuberculosis. Necrotizing granulomas with acid-fast bacilli were found on lung biopsy, but cultures were negative for Mycobacterium tuberculosis and no other pathogens were isolated. Polymerase chain reaction of lung biopsy tissue for all mycobacterial species was positive only for M. tuberculosis. Rapid clinical improvement followed corticosteroid therapy. After initiating HAART, clinicians should be aware of the possibility of an inflammatory response to a previously quiescent tuberculous infection, even while on antituberculosis therapy.
Kunimoto
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Department of Medical Microbiology and Immunology, University of Alberta, Canada. Dennis.Kunimoto@Ualberta.ca
Chui
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Nobert
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Houston
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D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000188:drug therapy / Q000208:ethnology / Q000276:immunology; D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects*; D000995:Antitubercular Agents / Q000627:therapeutic use; D002170:Canada; D004359:Drug Therapy, Combination; D015497:HIV-1; D006801:Humans; D008297:Male; D012131:Respiratory Insufficiency / Q000188:drug therapy / Q000209:etiology; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000188:drug therapy / Q000208:ethnology / Q000276:immunology; D014744:Vietnam / Q000208:ethnology
D000305:Adrenal Cortex Hormones; D019380:Anti-HIV Agents; D000995:Antitubercular Agents