Immune reconstitution inflammatory syndrome following disseminated TB with cerebral venous thrombosis in HIV-negative women during their postpartum period: a case report

Immune reconstitution inflammatory syndrome (IRIS) is characterized by exuberant and dysregulated inflammatory responses to invading microorganisms. IRIS associated with tuberculosis (TB-IRIS) is widely known in HIV-positive patients after starting highly active antiretroviral therapy (HAART) therapy. However, IRIS has also been observed in solid organ transplant recipients, neutropenic patients, tumor necrosis factor antagonist recipients, and women during the postpartum period despite their HIV status. CASE PRESENTATION: We report an exceptional case of a 19-year-old HIV-negative lady who presented as IRIS following disseminated TB with cerebral venous thrombosis during her postpartum period. After 1 month of starting anti-TB therapy, we found a paradoxical worsening of her symptoms and further deterioration of radiological features showing extensive tubercular spondylodiscitis involving almost all the vertebral with extensive prevertebral and paravertebral soft tissue collections. Significant improvement was observed after 3 months of continuation of steroids along with an adequate dose of anti-TB therapy. DISCUSSION: The possible mechanism that could explain this dysregulated and exuberant immune response in HIV-negative postpartum women would be rapidly changing immunologic repertoire, as the recovery of the immune system causes an abrupt shift of host immunity from an anti-inflammatory and immunosuppressive status toward a pathogenic proinflammatory state. Its diagnosis mostly depends on having a high degree of suspicion and ruling out alternative etiology. CONCLUSION: Therefore, clinicians should be aware of the paradoxical worsening of TB-related symptoms and/or radiological features at the primary site of infection or new location following an initial improvement in adequate anti-TB therapy despite HIV status.