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Complexity of Mycobacterium avium complex immune reconstitution inflammatory syndrome (MAC-IRIS) in a patient with HIV
  1. Thelma Xerri1,
  2. Janice Borg2,
  3. Ramon Casha1 and
  4. Claudia Fsadni1
  1. 1Infectious Diseases Unit, Mater Dei Hospital, Msida, Malta
  2. 2Department of Medicine, Mater Dei Hospital, Msida, Malta
  1. Correspondence to Dr Janice Borg; janice.c.borg{at}gov.mt

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.

  • HIV / AIDS
  • TB and other respiratory infections
  • infectious diseases

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Footnotes

  • Contributors JB and TX were responsible for the manuscript preparation and literature review. RC and CF contributed towards editing and review of the final manuscript. All authors were involved in the patient’s management and treatment.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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