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

You answered:

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.

This answer is incorrect. Although this patient possibly has a new opportunistic infection, the history is more consistent with the development of TB-IRIS, and an intensive investigation for a new opportunistic infection is not warranted based on his current clinical course.

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