Question | Discussion | References

Diagnosis and Management of Tuberculosis Immune Reconstitution Inflammatory Syndrome (TB-IRIS)

You answered:

A Optimal management at this point consists of administering corticosteroids, continuing TB therapy, and withholding antiretroviral therapy until his clinical symptoms improve and his chest radiograph has cleared.

This answer is incorrect. Discontinuation of antiretroviral therapy would be indicated only if his clinical condition were to deteriorate significantly in the setting of TB immune reconstitution inflammatory syndrome.

Choose another answer:

B The patient has likely developed multidrug-resistant TB; his TB regimen should empirically be changed and antiretroviral therapy should be continued.
C Given that his CD4 count is still less than 200 cells/mm3, a new opportunistic infection best explains the worsening clinical course and he should undergo an intensive evaluation for a new opportunistic infection.
D Optimal management at this point consists of continuing antiretroviral medications and TB therapy without change, obtaining sputum cultures to rule out drug-resistant TB, and administering corticosteroids if his clinical condition deteriorates further.

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