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

You answered:

	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.

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