CTICasesReactivation tuberculosis with immune reconstitution inflammatory syndrome (IRIS)
Imaging findings
CT scan of a severely immunocompromised HIV patient shows upper-lobe predominant miliary nodules and cystic change. A repeat CT scan days after starting antiretroviral and anti-tuberculosis therapy demonstrates rapid, massive necrotic destruction of the lung parenchyma and a pneumothorax.
Key takeaways
Immune reconstitution inflammatory syndrome (IRIS) in HIV patients treated for tuberculosis can cause an exaggerated inflammatory response, leading to rapid, destructive necrotic changes in the lung and pneumothorax.
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