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. 2018 Sep 15;13(6):512–521. doi: 10.1097/COH.0000000000000502

FIGURE 2.

FIGURE 2

Paradoxical TB-IRIS case illustrations. Patient (a) was a 29-year-old man, with a CD4 count of 14 cells/μl, who had been on TB treatment for 1 month. He complained of loss of appetite, 4 kg weight loss and recurrence of cough and chest pain 2 weeks after starting ART. Chest radiograph shows extension of the left hilar infiltrate. His C-reactive protein had increased from 11 mg/l before the start of ART to 292 mg/l. His symptoms spontaneously resolved 2 weeks later. Patient (b) was a 36-year-old man, with a CD4 count of 73 cells/μl, who had been on TB treatment for 3 weeks. One week after starting ART, he complained about poor appetite, gradually worsening with dyspnoea, cough, night sweats, diarrhoea, vomiting and fatigue. He was tachypnoeic, with a temperature of 38°C. Chest radiograph showed an increase in hilar and paratracheal lymphadenopathy. His C-reactive protein had increased from 4 mg/l before the start of ART to 120 mg/l. He was started on prednisone treatment, resulting in complete resolution of his symptoms over the next few weeks.