Lymph node tuberculosis-associated paradoxical immune reconstitution inflammatory syndrome in a non-HIV patient: Case report and review of literature

Tuberculosis (TB) is a global health threat, especially in HIV patients who may experience immune reconstitution inflammatory syndrome (IRIS) upon Mycobacterium tuberculosis infection. Diagnosing and defining IRIS in non-HIV patients remains challenging. A 63-year-old male with acute leukaemia underwent induction therapy with a regimen containing fludarabine. Febrile neutropenia led to further investigations, revealing non-cavitary pulmonary TB, prompting anti-tuberculosis therapy (ATT) alongside resumed leukaemia treatment with sorafenib. Persistent extra-pulmonary TB, specifically lymph node involvement, were observed and IRIS was suspected, evidenced by enlarged lymphadenopathies, scrofula, and skin lesions that developed during the 13-month course of ATT, with no recurrence after its cessation. This article explores a case of lymph node TB-associated paradoxical IRIS in a non-HIV leukaemia patient, revealing the intricate interplay between tuberculosis and haematological malignancies and emphasizing the lack of standardized diagnostic criteria and treatment consensus. Challenges in lymph node TB diagnosis and management highlight the need for tailored therapeutic approaches. The report explores the potential immunomodulatory effects of fludarabine and sorafenib, questioning their roles in TB-IRIS. This case illuminates TB-IRIS dynamics in non-HIV patients, urging further research and collaborative efforts to enhance understanding and outcomes. As medical complexities persist, personalized therapeutic approaches and advancements in TB-IRIS research are crucial.