title: Immune Reconstitution Inflammatory Syndrome (IRIS) with acute tuberculous osteomyelitis and disseminated mutilating tuberculous dactylitis in a person living with HIV and AIDS (PLHA): a case report.
abstract: HIV infection changed the scenario of infectious diseases. The pre-HAART (highly active antiretroviral therapy) era had resulted in new opportunistic infections. HIV and tuberculosis together had high mortality in countries with high prevalence of tuberculosis. Disseminated and extra pulmonary tuberculosis is common in PLHA (People Living with HIV and AIDS). IRIS (Immune Reconstitution Inflammatory Syndrome) after HAART is common (10% to 25%) in PLHA. Pott's spine is the most common presentation in PLHA of bone and skeletal system. IRIS tuberculosis, especially extra pulmonary tuberculosis, is the most common. In this case, we are presenting an IRIS disseminated tuberculosis in the form of acute osteomyelitis and mutilating dactylitis involving many joints of the fingers. Of 37 cases (9 from India) reported worldwide multiple dactylitis was never presented in the medical journals. This might be the first multiple dactylitis with extensive mutilation to the dactyls due to IRIS in a patient on ART.
authors: 1Center of Excellence for HIV and TB, Government Hospital of Thoracic Medicine, Tambaram, Chennai, Tamil Nadu, India.
authors: Raja
authors: R
authors: Krishnaraj
authors: Chandrasekar
authors: C
authors: Chockalingam
authors: O R
authors: OR
authors: Krishnarajasekhar
authors: Mahilmaran
authors: M
authors: Ayyamperumal
authors: Ravichandran
authors: R
authors: Narayanan
authors: Kumar
authors: K
authors: Satagopan
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000382:microbiology*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019380:Anti-HIV Agents / Q000009:adverse effects; D002443:Ceftriaxone / Q000627:therapeutic use; D003023:Cloxacillin / Q000627:therapeutic use; D005384:Finger Joint; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000150:complications*; D007711:Klebsiella pneumoniae; D008297:Male; D010019:Osteomyelitis / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*; D011859:Radiography; D014033:Toe Joint; D014394:Tuberculosis, Osteoarticular / Q000150:complications* / Q000000981:diagnostic imaging
chemical_list: D000900:Anti-Bacterial Agents; D019380:Anti-HIV Agents; D002443:Ceftriaxone; D003023:Cloxacillin