Paralytic Ileus during Treatment of Pulmonary and Renal Tuberculosis in a Non-Human Immunodeficiency Virus Patient: An Unusual Presentation of Tuberculosis-immune Reconstitution Inflammatory Syndrome

Intern Med. 2023 Sep 1;62(17):2559-2564. doi: 10.2169/internalmedicine.0898-22. Epub 2023 Jan 15.

Abstract

Paralytic ileus as tuberculosis-immune reconstitution inflammatory syndrome (TB-IRIS) is extremely rare. We herein report a 44-year-old man with pulmonary and renal tuberculosis who developed paralytic ileus 14 days after starting antituberculosis therapy (ATT) despite an initial favorable response to ATT. Paralytic ileus was successfully managed with conservative care. He initially required hemodialysis because of obstructive uropathy due to renal tuberculosis, but he was able to withdraw from dialysis after placement of ureteral stents. TB-IRIS can affect organs other than the original sites of tuberculosis, and the combined use of steroids may be effective for its prevention and treatment.

Keywords: abdominal symptoms; hemodialysis; paralytic ileus; steroids; tuberculosis; tuberculosis-immune reconstitution inflammatory syndrome.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antitubercular Agents* / therapeutic use
  • Humans
  • Immune Reconstitution Inflammatory Syndrome* / complications
  • Immune Reconstitution Inflammatory Syndrome* / drug therapy
  • Intestinal Pseudo-Obstruction* / diagnosis
  • Intestinal Pseudo-Obstruction* / ethnology
  • Male
  • Tomography, X-Ray Computed
  • Tuberculosis, Pulmonary* / complications
  • Tuberculosis, Pulmonary* / diagnostic imaging
  • Tuberculosis, Pulmonary* / drug therapy
  • Tuberculosis, Renal* / complications
  • Tuberculosis, Renal* / diagnostic imaging
  • Tuberculosis, Renal* / drug therapy

Substances

  • Antitubercular Agents