CTICasesImmune Reconstitution Inflammatory Syndrome in Disseminated Tuberculosis
Imaging findings
Baseline CT in a patient with untreated HIV/AIDS shows diffuse miliary pulmonary nodules, splenic lesions, and low-attenuation necrotic lymphadenopathy. Follow-up CT after the initiation of highly active antiretroviral therapy (HAART) shows resolution of the miliary nodules but paradoxical enlargement of the mediastinal, hilar, and axillary lymph nodes, along with new endobronchial soft tissue obstruction. This clinical and imaging picture is consistent with tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS).
Key takeaways
IRIS occurs when a recovering immune system (following HAART initiation in HIV/AIDS) mounts a paradoxical, hyper-inflammatory response to a pre-existing pathogen like Mycobacterium tuberculosis. Radiographically, it is characterized by worsening lymphadenopathy, new airway obstruction, or worsening parenchymal infiltrates despite an overall decrease in viral load and clinical improvement.
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