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Open Access Case report

Immune reconstitution inflammatory syndrome presenting as chylothorax in a patient with HIV and Mycobacterium tuberculosis coinfection: a case report

Jiun-Nong Lin123, Chung-Hsu Lai13, Yen-Hsu Chen345, Lin-Li Chang3, Susan Shin-Jung Lee6 and Hsi-Hsun Lin17*

Author Affiliations

1 Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan

2 Department of Critical Care Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan

3 Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

4 Tropical Medicine Research Institute, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

5 Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

6 Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

7 Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan

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BMC Infectious Diseases 2010, 10:321  doi:10.1186/1471-2334-10-321

Published: 8 November 2010

Abstract

Background

Patients with human immunodeficiency virus (HIV) infection are at risk for Mycobacterium tuberculosis (TB) coinfection. The advent of antiretroviral therapy restores immunity in HIV-infected patients, but predisposes patients to immune reconstitution inflammatory syndrome (IRIS).

Case Presentation

A 25-year-old HIV-infected male presented with fever, productive cough, and body weight loss for 2 months. His CD4 cell count was 11 cells/μl and HIV-1 viral load was 315,939 copies/ml. Antituberculosis therapy was initiated after the diagnosis of pulmonary TB. One week after antituberculosis therapy, antiretroviral therapy was started. However, multiple mediastinal lymphadenopathies and chylothorax developed. Adequate drainage of the chylothorax, suspension of antiretroviral therapy, and continued antituberculosis therapy resulted in successful treatment and good outcome.

Conclusions

Chylothorax is a rare manifestation of TB-associated IRIS in HIV-infected patients. Careful monitoring for development of IRIS during treatment of HIV-TB coinfection is essential to minimize the associated morbidity and mortality.