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Neurologic Manifestations of Paradoxical Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome: A Case Series
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Neurologic Manifestations of Paradoxical Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome: A Case Series
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Journal Article
Neurologic Manifestations of Paradoxical Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome: A Case Series
2009
Overview
Background. Paradoxical neurologic tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is a potentially life-threatening condition that occurs within 3 months after starting combination antiretroviral therapy (ART). The reports in the published literature are anecdotal, and the prevalence and outcomes of neurologic TB-IRIS are unknown. Methods. We prospectively assessed patients with suspected TB-IRIS from June 2005 through October 2007 at our hospital in Cape Town, South Africa. We defined paradoxical TB-IRIS and paradoxical neurologic TB-IRIS with use of consensus clinical case definitions. We collected data on tuberculosis diagnosis, ART, details of TB-IRIS diagnosis, other opportunistic infections, corticosteroid use, and outcome. Results. We reviewed 279 patients with suspected TB-IRIS, 54 (19%) of whom had suspected neurologic TB-IRIS, and 225 (81%) of whom had suspected non-neurologic TB-IRIS. Paradoxical TB-IRIS was diagnosed in 190 patients; 23 (12%) of these 190 patients had neurologic TB-IRIS (95% confidence interval, 7%–17%). Eight had meningitis, 7 had tuberculoma, 5 had both tuberculoma and meningitis, and 3 had radiculomyelopathy. Twenty (87%) of the 23 patients with neurologic TB-IRIS required hospital admission (median duration, 12 days; interquartile range, 6–24 days), and 21 (91%) received corticosteroids (median duration, 58 days; interquartile range, 29–86 days). Outcomes 6 months after the initial assessment for neurologic deterioration were as follows: 16 (70%) of the patients were alive (10 of these patients had documented full physical and mental recovery), 3 (13%) were dead, and 4 (17%) were lost to follow-up. Conclusions. Paradoxical neurologic TB-IRIS accounts for 12% of paradoxical TB-IRIS cases. Neurologic TB-IRIS causes considerable short-term morbidity but has reasonable long-term outcomes. Further research is needed to devise optimal diagnostic and management strategies for patients with tuberculosis who experience neurologic deterioration after starting ART.
Publisher
The University of Chicago Press
Subject
Adrenal Cortex Hormones - therapeutic use
/ Adult
/ Anti-HIV Agents - adverse effects
/ Anti-HIV Agents - therapeutic use
/ Antiretroviral Therapy, Highly Active - adverse effects
/ Female
/ HIV Infections - drug therapy
/ Humans
/ Immune Reconstitution Inflammatory Syndrome - pathology
/ Immune Reconstitution Inflammatory Syndrome - physiopathology
/ Male
/ Tuberculoma - physiopathology
/ Tuberculosis, Central Nervous System - pathology
/ Tuberculosis, Central Nervous System - physiopathology
/ Tuberculosis, Meningeal - pathology
