PMID- 27451593
OWN - NLM
STAT- MEDLINE
DCOM- 20160818
LR  - 20160725
IS  - 2067-2993 (Print)
IS  - 2067-2993 (Linking)
VI  - 64
IP  - 4
DP  - 2015 Oct-Dec
TI  - Immune reconstitution inflammatory syndrome in central nervous system 
      tuberculosis.
PG  - 32-6
AB  - 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). CONCLUSION: 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.
FAU - Manea, Eliza
AU  - Manea E
FAU - Munteanu, Daniela
AU  - Munteanu D
FAU - Jipa, Raluca
AU  - Jipa R
FAU - Moroti, Ruxandra
AU  - Moroti R
FAU - Arama, Victoria
AU  - Arama V
FAU - Diaconu, Ioan-Alexandru
AU  - Diaconu IA
FAU - Hristea, Adriana
AU  - Hristea A
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - Romania
TA  - Pneumologia
JT  - Pneumologia (Bucharest, Romania)
JID - 100941067
RN  - 0 (Anti-HIV Agents)
RN  - 0 (Antitubercular Agents)
RN  - 0 (Glucocorticoids)
SB  - IM
MH  - Adult
MH  - Anti-HIV Agents/therapeutic use
MH  - Antitubercular Agents/therapeutic use
MH  - Drug Therapy, Combination
MH  - Glucocorticoids/therapeutic use
MH  - HIV Infections/*complications/drug therapy
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/diagnosis/drug therapy/*etiology
MH  - *Immunocompromised Host
MH  - Male
MH  - Middle Aged
MH  - Risk Factors
MH  - Spondylitis, Ankylosing/complications
MH  - Treatment Outcome
MH  - Tuberculosis, Central Nervous System/*complications/diagnosis/drug therapy
EDAT- 2016/07/28 06:00
MHDA- 2016/08/19 06:00
CRDT- 2016/07/26 06:00
PHST- 2016/07/26 06:00 [entrez]
PHST- 2016/07/28 06:00 [pubmed]
PHST- 2016/08/19 06:00 [medline]
PST - ppublish
SO  - Pneumologia. 2015 Oct-Dec;64(4):32-6.