PMID- 37228988
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230530
IS  - 2049-0801 (Print)
IS  - 2049-0801 (Electronic)
IS  - 2049-0801 (Linking)
VI  - 85
IP  - 5
DP  - 2023 May
TI  - Immune reconstitution inflammatory syndrome following disseminated TB with 
      cerebral venous thrombosis in HIV-negative women during their postpartum period: 
      a case report.
PG  - 1932-1939
LID - 10.1097/MS9.0000000000000446 [doi]
AB  - Immune reconstitution inflammatory syndrome (IRIS) is characterized by exuberant 
      and dysregulated inflammatory responses to invading microorganisms. IRIS 
      associated with tuberculosis (TB-IRIS) is widely known in HIV-positive patients 
      after starting highly active antiretroviral therapy (HAART) therapy. However, 
      IRIS has also been observed in solid organ transplant recipients, neutropenic 
      patients, tumor necrosis factor antagonist recipients, and women during the 
      postpartum period despite their HIV status. CASE PRESENTATION: We report an 
      exceptional case of a 19-year-old HIV-negative lady who presented as IRIS 
      following disseminated TB with cerebral venous thrombosis during her postpartum 
      period. After 1 month of starting anti-TB therapy, we found a paradoxical 
      worsening of her symptoms and further deterioration of radiological features 
      showing extensive tubercular spondylodiscitis involving almost all the vertebral 
      with extensive prevertebral and paravertebral soft tissue collections. 
      Significant improvement was observed after 3 months of continuation of steroids 
      along with an adequate dose of anti-TB therapy. DISCUSSION: The possible 
      mechanism that could explain this dysregulated and exuberant immune response in 
      HIV-negative postpartum women would be rapidly changing immunologic repertoire, 
      as the recovery of the immune system causes an abrupt shift of host immunity from 
      an anti-inflammatory and immunosuppressive status toward a pathogenic 
      proinflammatory state. Its diagnosis mostly depends on having a high degree of 
      suspicion and ruling out alternative etiology. CONCLUSION: Therefore, clinicians 
      should be aware of the paradoxical worsening of TB-related symptoms and/or 
      radiological features at the primary site of infection or new location following 
      an initial improvement in adequate anti-TB therapy despite HIV status.
CI  - Copyright (c) 2023 the Author(s). Published by Wolters Kluwer Health, Inc.
FAU - Yadav, Prashant
AU  - Yadav P
AUID- ORCID: 0000-0001-6902-1262
AD  - Department of Medicine, Sir Salimullah Medical College and Mitford Hospital, 
      Dhaka.
FAU - Bari, Md Anwarul
AU  - Bari MA
AUID- ORCID: 0000-0001-5997-2021
AD  - Department of Medicine, Sir Salimullah Medical College and Mitford Hospital, 
      Dhaka.
FAU - Yadav, Sushmita
AU  - Yadav S
AD  - Jalalabad Ragib-Rabeya Medical College, Sylhet, Bangladesh.
FAU - Khan, Amzad H
AU  - Khan AH
AD  - Department of Medicine, Sir Salimullah Medical College and Mitford Hospital, 
      Dhaka.
LA  - eng
PT  - Journal Article
DEP - 20230401
PL  - England
TA  - Ann Med Surg (Lond)
JT  - Annals of medicine and surgery (2012)
JID - 101616869
PMC - PMC10205385
OTO - NOTNLM
OT  - case report
OT  - cerebral venous thrombosis
OT  - disseminated TB
OT  - immune reconstitution inflammatory syndrome
OT  - postpartum women
COIS- There are no conflicts of interest.
EDAT- 2023/05/25 19:12
MHDA- 2023/05/25 19:13
PMCR- 2023/04/01
CRDT- 2023/05/25 14:18
PHST- 2023/01/12 00:00 [received]
PHST- 2023/03/16 00:00 [accepted]
PHST- 2023/05/25 19:13 [medline]
PHST- 2023/05/25 19:12 [pubmed]
PHST- 2023/05/25 14:18 [entrez]
PHST- 2023/04/01 00:00 [pmc-release]
AID - 10.1097/MS9.0000000000000446 [doi]
PST - epublish
SO  - Ann Med Surg (Lond). 2023 Apr 1;85(5):1932-1939. doi: 
      10.1097/MS9.0000000000000446. eCollection 2023 May.