Question | Discussion | References

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

You answered:

B The patient has likely developed multidrug-resistant TB; his TB regimen should empirically be changed and antiretroviral therapy should be continued.

This answer is incorrect. Although this patient possibly has drug-resistant tuberculosis, the clinical course and negative AFB smear 2 months into treatment are more consistent with TB immune reconstitution inflammatory syndrome. It would be premature to change his anti-tuberculosis regimen at this time without additional evidence of drug-resistant TB.

Choose another answer:

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.
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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