The dynamic changes of recurrent Immune reconstitution inflammatory syndrome of an AIDS patient with cytomegalovirus encephalitis and pulmonary tuberculosis：a case report

Abstract

Background This study describes an AIDS patient with central nervous systems tuberculosis, and cytomegalovirus infection who experienced immune reconstitution inflammatory syndromes associated to cytomegalovirus encephalitis and pulmonary tuberculosis while receiving antiretroviral therapy. Case presentation A 59-year-old male with fever of unknown origin with dizziness, fatigue, loss of appetite, fear of cold, occasional babbling during fever, and paroxysmal cough as the main symptoms three days was referred to our hospital Cerebrospinal fluid examination showed a cytomegaloviral load of 3.4×103 copies/ml and a positive mycobacterium tuberculosis recombination test. Cerebrospinal fluid gene X-pert MTB/RIF test showed mycobacterium tuberculosis infection without rifampicin resistance. Anti-tuberculosis treatment and anti-cytomegalovirus therapy were administered, and clinical and laboratory abnormalities were improved. The patient's CD4+ T lymphocyte count was 70 cells/μl, and antiretroviral therapy was started 24 days after the start of anti-tuberculosis treatment. Clinical symptoms reappeared on day 33 after antiretroviral therapy treatment. Relapsing - immune reconstitution inflammatory syndrome was considered as the most likely diagnosis. After the addition of a small amount of dexamethasone to continue anti-tuberculosis and anti-cytomegalovirus therapy, the patient's symptoms disappeared and imaging was reduced in scope. There was no recurrence of clinical symptoms at 2 years of outpatient follow-up. Conclusion It is important to take aware of the emergence of multiple infections and the associated immune reconstitution inflammatory syndrome in AIDS. Once the immune reconstitution inflammatory syndrome manifests, a proper diagnosis and continual of treatment are imperative to the patient's recovery.