title: Severe Mycobacterium tuberculosis-related immune reconstitution syndrome in an immunocompetent patient.
abstract: We present a young immunocompetent male with diagnosed sputum culture-positive tuberculosis on intensive phase with observed daily four-drug antituberculosis therapy. He presented at 1-month of treatment with sequential bilateral pneumothoraces, increase in cavitation and consolidation and respiratory failure. Repeat smears for acid-fast bacilli had downgraded, and cultures were negative. Quantiferon-GOLD (initially negative) was now strongly positive. A diagnosis of possible immune reconstitution syndrome was considered and 0.25 mg/kg/day oral steroids administered. We also discuss an approach to differential diagnosis of a patient worsening on treatment for microbiologically confirmed tuberculosis in this manuscript.
authors.affiliation: Department of Medicine and Medical Intensive Care, Jawaharlal Nehru Institute of Postgraduate Medical Education and Research, Puducherry, Chennai, India ; Department of Microbiology, Global Hospitals and Health City, Perumbakkam, Chennai, India.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Rajagopala
authors.affiliation: Department of Microbiology, Global Hospitals and Health City, Perumbakkam, Chennai, India.
authors.forename: Sujatha
authors.initials: S
authors.lastname: Chandrasekharan
keywords: Immune reconstitution; Vitamin D; pneumothorax; respiratory failure; tuberculosis