Complexity of Mycobacterium avium complex immune reconstitution inflammatory syndrome (MAC-IRIS) in a patient with HIV

Abstract

We report a case of Mycobacterium avium complex immune reconstitution inflammatory syndrome (MAC-IRIS) in a patient with HIV positive. Initial presentation was that of a purpuric purple macular rash in-keeping with Kaposi sarcoma as an AIDS defining illness. Three weeks following the initiation of antiretroviral treatment (ART) she developed chest pain, dry cough and fever. A diagnosis of MAC was made through imaging and sputum cultures and appropriate treatment was initiated. Despite adequate management with evidence of good immunological and virological response, the patient represented with persistent symptoms. Repeat CT of the chest confirmed worsening lymphadenopathy with necrosis. Given these findings, a diagnosis of MAC-IRIS was made with resolution of fever after corticosteroids were initiated. This case highlights the importance of considering MAC as a cause of IRIS in severely immunosuppressed patients with HIV.

Keywords: HIV / AIDS; TB and other respiratory infections; infectious diseases.

Figure 1

Violaceous macular rash consistent with Kaposi sarcoma.

Figure 2

(A) Baseline chest X-ray (CXR) showing bilateral perihilar shadowing and widening of the right paratracheal stripe. (B) Repeat CXR on second presentation, 3 weeks after showing interim increase in the bilateral hilar enlargement with right apical consolidation.

Figure 3

(A) Initial CT thorax showing bilateral hilar and superior mediastinal lymphadenopathy, the majority of which demonstrate features of necrosis. (B) Repeat CT thorax 3 weeks after presentation showing an increase in size of the previously described bilateral hilar and mediastinal lymphadenopathy.