Thoracic manifestations of paradoxical immune reconstitution inflammatory syndrome during or after antituberculous therapy in HIV-negative patients

Pornsuriyasak, Prapaporn; Suwatanapongched, Thitiporn

doi:10.5152/dir.2014.14212

Cited by 12 publications

(6 citation statements)

References 15 publications

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“…While the prognosis of TB is relatively good and ≥95% patients may have improved health condition [29], the TB mortality rate was reportedly 12.3% in the culture-positive group [30], and 10.5% in pulmonary TB group [31]. Diabetes mellitus, sputum smear-positive TB, anemia, smoking, and drug-induced hepatitis increased the mortality rate [31].…”

Section: Discussionmentioning

confidence: 99%

Treatment with Tumor Necrosis Factor-α Inhibitors, History of Allergy, and Hypercalcemia Are Risk Factors of Immune Reconstitution Inflammatory Syndrome in HIV-Negative Pulmonary Tuberculosis Patients

Hachisu

Koga

Kasama

et al. 2019

JCM

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Immune reconstitution inflammatory syndrome (IRIS) is an immune reaction that occurs along with the recovery of the patient’s immunity. Tuberculosis-related IRIS (TB-IRIS) upon tumor necrosis factor (TNF)-α inhibitor treatment has been reported in non-human immunodeficiency virus (HIV) patients. However, the importance of biological treatment, as a risk factor of IRIS, has not yet been established. In this study, we examined TB-IRIS in non-HIV patients to explore the role of TNF-α inhibitor treatment. Out of 188 patients with pulmonary TB, seven patients had IRIS. We examined univariate logistic and multivariate analysis to elucidate risk factors of TB-IRIS. Univariate analysis indicated that usage of immunosuppressive drugs, TNF-α inhibitors, and history of food or drug allergy were significantly related with TB-IRIS. On initial treatment, the values of serological markers such as serum albumin and serum calcium were significantly related with TB-IRIS. There was a higher mortality rate in patients with TB-IRIS. Furthermore, multivariate analysis revealed that usage of TNF-α inhibitors, history of allergy, and serum hypercalcemia were related to TB-IRIS. Usage of TNF-α inhibitors, history of allergy, and serum hypercalcemia may be independent predictors of TB-IRIS in non-HIV patients. Since higher mortality has been reported for TB-IRIS, we should pay attention to TB patients with these risk factors.

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Section: Discussionmentioning

confidence: 99%

Treatment with Tumor Necrosis Factor-α Inhibitors, History of Allergy, and Hypercalcemia Are Risk Factors of Immune Reconstitution Inflammatory Syndrome in HIV-Negative Pulmonary Tuberculosis Patients

Hachisu

Koga

Kasama

et al. 2019

JCM

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“…Regardless of the sites of primary TB, TB‐IRIS mainly involves the lymph nodes (68%) and lungs (16%) 1 . Various thoracic manifestations in TB‐IRIS include new pulmonary parenchymal lesions, enlarging pre‐existing lymphadenopathy or new lymphadenopathy, progression of pre‐existing pleural effusion or new pleural effusion, new chest or abdominal wall lesions and endobronchial lesions 13 . TB‐IRIS usually develops in the ipsilateral side of primary TB, hence contralateral or bilateral lesions can also occur 14 …”

Section: Discussionmentioning

confidence: 99%

Tuberculosis‐immune reconstitution inflammatory syndrome in HIV‐negative children

Palamit

Tovichien

Amornsitthiwat

2022

Respirology Case Reports

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Even though tuberculosis‐immune reconstitution inflammatory syndrome (TB‐IRIS) is usually found in HIV‐positive patients receiving antiviral treatment, it can also occur in HIV‐negative patients especially if they have risk factors. We report a unique case of TB‐IRIS in an immunocompetent child presenting with new onset of pleuritic chest pain after receiving anti‐TB drugs. TB‐IRIS should be considered as a differential diagnosis in case of clinical deterioration or appearance of new typical lesions despite appropriate anti‐TB treatment for more than 2 weeks in the absence of persistently active TB or any other alternative causes. This will prevent physicians from misdiagnosis as superimposed infections, treatment failure or TB relapse.

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“…Therefore, strict adherence to a universal definition of TB-IRIS is fundamental. Although elaborated for HIV-positive patients in a low-income setting, 6 we generally suggest to follow the definition of TB-IRIS developed by INSHI. 7 Although TB, HIV and, in this context, TB-IRIS are in particular major problems of low-income countries, physicians in high-income settings should be familiar with this phenomenon.…”

Section: Discussionmentioning

confidence: 99%

Approach for tuberculosis-associated immune reconstitution inflammatory syndrome in an HIV-negative patient

Weber

Fehr

Kuhn³

et al. 2021

BMJ Case Rep

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A male refugee from the Middle East was diagnosed with pulmonary tuberculosis and Pott’s disease with paravertebral abscess. After starting the standard regimen, the sputum culture converted to negative and the patient’s general condition improved. Six weeks later, the patient presented with clinical worsening of known symptoms, new appearance of focal neurological deficits and progress of radiological features showing progression of the paravertebral abscess. Immune reconstitution inflammatory syndrome with Mycobacterium tuberculosis (TB-IRIS) was presumed, and treatment with high-dose steroids was started. Due to recurrent relapses while tapering, corticosteroids had to be given over a prolonged period. After treatment completion, the patient was in a good general condition, abscesses had decreased and neurological deficits were in complete remission. This case presents the rare manifestation of TB-IRIS in HIV-negative patients and its management in a high-income country.

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Thoracic manifestations of paradoxical immune reconstitution inflammatory syndrome during or after antituberculous therapy in HIV-negative patients

Cited by 12 publications

References 15 publications

Treatment with Tumor Necrosis Factor-α Inhibitors, History of Allergy, and Hypercalcemia Are Risk Factors of Immune Reconstitution Inflammatory Syndrome in HIV-Negative Pulmonary Tuberculosis Patients

Treatment with Tumor Necrosis Factor-α Inhibitors, History of Allergy, and Hypercalcemia Are Risk Factors of Immune Reconstitution Inflammatory Syndrome in HIV-Negative Pulmonary Tuberculosis Patients

Tuberculosis‐immune reconstitution inflammatory syndrome in HIV‐negative children

Approach for tuberculosis-associated immune reconstitution inflammatory syndrome in an HIV-negative patient

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