A Case of Immune Reconstitution Inflammatory Syndrome (IRIS) in Musculoskeletal Tuberculosis: A Rare Clinical Presentation in a 14-year-old Patient

Abstract

Tuberculosis associated- Immune Reconstitution Inflammatory Syndrome (TB-IRIS) is a paradoxical deterioration or resurgence of pre-existing tuberculous lesions, or the emergence of new lesions, in individuals who are effectively undergoing anti-tuberculous treatment. This condition arises from an abnormal, excessive immune response to Mycobacterium in individuals who may, although rarely, not have Human Immunodeficiency Syndrome (HIV)-TB co-infection. This phenomenon may manifest during or even after the completion of therapy. In such cases, the initiation of concurrent steroid therapy has been found to improve symptoms by suppressing the excessive immune response. Hereby, the authors present a case report of 14-year-old teenage girl diagnosed with tuberculosis of the elbow who was started on anti-tuberculous therapy. After three months, she presented with multiple new lesions on her opposite forearm and leg. She underwent debridement of the lesions, and histopathological examination revealed a tuberculous aetiology. She was then started on concurrent steroid therapy for six weeks, following which her general condition improved, and there was no further development of new lesions.

Keywords

• antitubercular drugs
• debridement
• immune reconstitution inflammatory syndrome
• prednisolone