title: Immune reconstitution inflammatory syndrome in central nervous system tuberculosis.
abstract: BACKGROUND
  Immune reconstitution inflammatory syndrome (IRIS) related to tuberculosis (TB) is an exacerbation of an inflammatory response that most often occurs in HIV-infected patients but it has also been observed in non-HIV immunocompromised hosts. We describe two cases of TB associated IRIS with CNS involvement, one in a patient diagnosed with HIV infection and the other in a patient with immunosuppression due to anti tumor necrosis factor treatment. CASE REPORT; The first case was a 40-year-old man, newly diagnosed with HIV infection, who developed right hemiplegia and expressive aphasia. Lumbar puncture and MRI sustained the diagnosis of TB meningoencephalitis. He initially improved understandard antituberculous therapy (ATT). After 6 weeks of ATT antiretroviral treatment (ART) was initiated and one week later the patient experienced worsening of his symptoms (left hemiparesis and mixed aphasia), of CSF and MRI changes. He improved after he was starting on corticosteroids in tapering doses, with clinical deterioration at lower doses over a 5-month period. The second case was a 56-year-old male, treated for 3 years with Infliximab for ankylosing spondylitis. He was diagnosed with disseminated TB (CNS tuberculomas and pulmonary TB), histological and bacteriological confirmed the diagnosis. His neurological symptoms improved after starting ATT but after 2 weeks of therapy he presented with diplopia and generalized tonic-clonic seizures. These symptoms improved only after corticosteroids were added (tapering doses during the next 6 months).
  
  
  CONCLUSIONS
  TB-associated IRIS with CNS involvement is potentially life threatening. Corticosteroids should be used to control the IRIS symptoms in those patients. The dosing and duration should be tailored to each patient.
authors.forename: Eliza
authors.initials: E
authors.lastname: Manea
authors.forename: Daniela
authors.initials: D
authors.lastname: Munteanu
authors.forename: Raluca
authors.initials: R
authors.lastname: Jipa
authors.forename: Ruxandra
authors.initials: R
authors.lastname: Moroti
authors.forename: Victoria
authors.initials: V
authors.lastname: Arama
authors.forename: Ioan-Alexandru
authors.initials: IA
authors.lastname: Diaconu
authors.forename: Adriana
authors.initials: A
authors.lastname: Hristea
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013167:Spondylitis, Ankylosing / Q000150:complications; D016896:Treatment Outcome; D020306:Tuberculosis, Central Nervous System / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents; D005938:Glucocorticoids