Immune reconstitution inflammatory syndrome presenting as chylothorax in a patient with HIV and Mycobacterium tuberculosis coinfection: a case report.
BACKGROUND
Patients with human immunodeficiency virus (HIV) infection are at risk for Mycobacterium tuberculosis (TB) coinfection. The advent of antiretroviral therapy restores immunity in HIV-infected patients, but predisposes patients to immune reconstitution inflammatory syndrome (IRIS).


METHODS
A 25-year-old HIV-infected male presented with fever, productive cough, and body weight loss for 2 months. His CD4 cell count was 11 cells/μl and HIV-1 viral load was 315,939 copies/ml. Antituberculosis therapy was initiated after the diagnosis of pulmonary TB. One week after antituberculosis therapy, antiretroviral therapy was started. However, multiple mediastinal lymphadenopathies and chylothorax developed. Adequate drainage of the chylothorax, suspension of antiretroviral therapy, and continued antituberculosis therapy resulted in successful treatment and good outcome.


CONCLUSIONS
Chylothorax is a rare manifestation of TB-associated IRIS in HIV-infected patients. Careful monitoring for development of IRIS during treatment of HIV-TB coinfection is essential to minimize the associated morbidity and mortality.
Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan. ed100233@edah.org.tw
Jiun-Nong
JN
Lin
Chung-Hsu
CH
Lai
Yen-Hsu
YH
Chen
Lin-Li
LL
Chang
Susan Shin-Jung
SS
Lee
Hsi-Hsun
HH
Lin
D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002916:Chylothorax / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D004322:Drainage; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000473:pathology / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000139:chemically induced / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D014388:Tuberculosis, Lymph Node / Q000175:diagnosis / Q000473:pathology; D019562:Viral Load; D028761:Withholding Treatment
D019380:Anti-HIV Agents; D000995:Antitubercular Agents