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Paradoxical Reaction

 

Occasionally, patients with HIV-related TB may experience a temporary exacerbation of symptoms, signs, or radiographic manifestation of TB after beginning TB treatment due to simultaneous administration of Anti-retroviral Treatment (ART) and TB medication. It was thought to be a result of immune reconstitution and is referred to as the Immune Reconstitution Inflammatory Syndrome (IRIS).

 

Symptoms and Signs

 

  • High fever
  • Lymphadenopathy
  • Expanding intrathoracic lesions
  • Worsening of chest radiographic findings 

 

Diagnosis: Made only after a thorough evaluation has excluded other etiologies, particularly where TB treatment has failed

 

Treatment: For severe paradoxical reactions, prednisolone (1–2 mg/kg for 1–2 weeks, then gradually decreasing dose) may be used.

 

 

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