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Tuberculosis immune reconstitution syndrome (TB-IRIS) followed by recurring lymphadenitis up to 8 years post-antituberculous treatment
  1. Ole Skouvig Pedersen1,
  2. Trine Ørhøj Barkholt2,
  3. Stine Horskær Madsen3 and
  4. Frauke Rudolf4
  1. 1Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
  2. 2Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus N, Denmark
  3. 3Department of Pathology, Aarhus University Hospital, Aarhus N, Denmark
  4. 4Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark
  1. Correspondence to Ole Skouvig Pedersen; oleskouvigpedersen{at}


We present the case of a patient with HIV and tuberculosis (TB) coinfection who initially developed paradoxical TB immune reconstitution inflammatory syndrome (TB-IRIS) post-antituberculous treatment and post-antiretroviral therapy initiation. Despite being managed effectively, lymphadenitis recurred as many as three times over the course of several years. Due to consistent culture-negative lymph node biopsies, the recurring lymphadenitis was eventually deemed inflammatory rather than microbiological recurrences. Cessation of anti-TB treatment led to symptom remission followed by a long asymptomatic period, corroborating the immunological nature of the episodes. However, 5 and 6 years after cessation of anti-TB treatment, respectively, lymphadenitis returned. In both instances, her symptoms regressed without treatment with anti-TB drugs. This case underscores the complexities of managing TB-IRIS and the necessity of differentiating between paradoxical TB-IRIS and other paradoxical reactions for appropriate treatment decisions. Recognition of such distinctions is crucial in guiding effective therapeutic interventions in TB-HIV coinfection scenarios.

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

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  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content—OSP, FR, SHM and TØB. The following authors gave final approval of the manuscript—OSP, FR, SHM and TØB.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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