Prolonged paradoxical TB-IRIS: two case reports and a review of the literature

While paradoxical tuberculosis immune reconstitution inflammatory syndrome (TB-IRIS) in HIV-TB coinfection is typically thought of as occurring within several months of starting antiretroviral therapy, more prolonged manifestations have been reported. We describe two cases in which manifestations of TB-IRIS continued greater than one year after the end of TB treatment and review the literature on prolonged TB-IRIS. These cases are often characterized by a history of extrapulmonary TB and initially low CD4 counts and commonly demonstrate lymphadenitis or abscesses. In the absence of clear consensus around its appropriate management, prolonged TB-IRIS presents a significant diagnostic and therapeutic dilemma.