title: Isoniazid-resistant Mycobacterium kansasii in an HIV-positive patient, and possible development of immune reconstitution inflammatory syndrome after initiation of highly active antiretroviral therapy: case report.
abstract: Non-tuberculous mycobacteria are rare but important causes of infection in HIV-positive individuals. A 28-year-old HIV-positive male presented with a high fever, non-productive cough, right subcostal pain, splenomegaly, a very low CD4 count, elevated C-reactive protein and erythrocyte sedimentation rate, and a normal white blood cell count. The suspicion of tuberculosis (TB) was very high, and sputum samples were positive for acid-fast bacilli. Standard quadruple anti-TB therapy was initiated, but once culture of the sample revealed Mycobacterium kansasii, pyrazinamide was withdrawn. Highly active antiretroviral therapy (HAART) was initiated soon after, consisting of abacavir/lamivudine and efavirenz. The patient's general condition deteriorated 2 weeks after HAART initiation, which could have been due to the development of immune reconstitution inflammatory syndrome (IRIS). The patient recovered and was discharged in good condition. However, the results of resistance testing of the isolated organism arrived after discharge, and showed isoniazid and streptomycin resistance. This is the first case report of M. kansasii infection from Serbia and shows the difficulties encountered during the course of treatment.
authors.affiliation: Department for HIV/AIDS, University Teaching Hospital for Infectious and Tropical Diseases, Clinical Centre of Serbia, Bul. Oslobodjenja 16, Belgrade, Serbia. Electronic address: alexadespotovic@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Despotovic
authors.affiliation: Institute for Microbiology and Immunology, National Reference Laboratory for Tuberculosis, Belgrade, Serbia; School of Medicine, University of Belgrade, Serbia.
authors.forename: B
authors.initials: B
authors.lastname: Savic
authors.affiliation: Department for HIV/AIDS, University Teaching Hospital for Infectious and Tropical Diseases, Clinical Centre of Serbia, Bul. Oslobodjenja 16, Belgrade, Serbia.
authors.forename: D
authors.initials: D
authors.lastname: Salemovic
authors.affiliation: Department for HIV/AIDS, University Teaching Hospital for Infectious and Tropical Diseases, Clinical Centre of Serbia, Bul. Oslobodjenja 16, Belgrade, Serbia; School of Medicine, University of Belgrade, Serbia.
authors.forename: J
authors.initials: J
authors.lastname: Ranin
authors.affiliation: Department for HIV/AIDS, University Teaching Hospital for Infectious and Tropical Diseases, Clinical Centre of Serbia, Bul. Oslobodjenja 16, Belgrade, Serbia; School of Medicine, University of Belgrade, Serbia.
authors.forename: Dj
authors.initials: D
authors.lastname: Jevtovic
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D000995:Antitubercular Agents / Q000494:pharmacology*; D006679:HIV Seropositivity / Q000382:microbiology*; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000209:etiology*; D007538:Isoniazid / Q000494:pharmacology*; D008297:Male; D019909:Mycobacterium kansasii / Q000187:drug effects / Q000302:isolation & purification*
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid
keywords: IRIS; Mycobacterial resistance; Mycobacterium kansasii; NTM; Serbia