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Table 2 Characteristics, treatment and clinical course for six patients in whom TB-IRIS duration was longer than 1 year

From: Prolonged tuberculosis-associated immune reconstitution inflammatory syndrome: characteristics and risk factors

  Age at TB-IRIS onset (years) Pre-ART
CD4 count (cells/μl)
Initial TB diagnosis Initial IRIS features Duration of TB-IRIS (days) Duration of steroid treatment (days) Features that persisted > 1 year Comments
1 35 78 Extra-pulmonary TB (nodal) Nodal 746 (IRIS ongoing at last visit) 70 Cerebellar tuberculomas/abscesses The initial TB-IRIS episode involved lymph nodes and resolved on prednisone then patient re-presented several months later with new neurological manifestations and multiple rim-enhancing lesions in the cerebellum. Brain abscess resection tissue cultured drug-susceptible MTB.
Experienced recurrence of TB-IRIS symptoms on tapering of steroids and required re-escalation of steroid doses.
2 34 160 Extra-pulmonary TB (nodal and miliary) Nodal 824 (IRIS ongoing at last visit) 98 Supraclavicular nodes and large cold abscess Experienced recurrence of TB-IRIS symptoms on tapering of steroids and required re-escalation of steroid doses.
3 56 65 Extra-pulmonary TB (miliary) Nodal 426 0 Cervical and submandibular nodes -
4 26 44 Extra-pulmonary TB (abdominal) Abdominal 462 168 Axillary and cervical nodes, abdominal wall cold abscesses, mastitis Patient found to have rifampicin mono-resistant MTB (urine culture sent at diagnosis) at TB-IRIS diagnosis. She was commenced on prednisone after commencement of appropriate treatment for rifampicin mono-resistant TB.
Experienced recurrence of TB-IRIS symptoms on tapering of steroids and required re-escalation of steroid doses.
5 36 39 Extra-pulmonary TB (nodal and abdominal) Nodal 1362 308 Multiple suppurating cervical nodes, psoas abscesses and abdominal pus collections Experienced recurrence of TB-IRIS symptoms on tapering of steroids and required re-escalation of steroid doses.
Patient still had residual left iliac fossa mass on abdominal imaging at TB-IRIS resolution that was decreasing in size and was asymptomatic.
6 39 80 Extra-pulmonary TB (nodal) Nodal 519 137 Lymph nodes and cold abscesses -
  1. Abbreviations: IRIS immune reconstitution inflammatory syndrome, MTB Mycobacterium tuberculosis, TB tuberculosis