Multifocal tuberculosis simulating immune restoration syndrome

The development of common tuberculosis in a human immunodeficiency virus (HIV) infected patient causes an increase in viral load, resulting in TCD4 lymphopenia. When it develops three months following the initiation of an antiretroviral therapy (ART), its manifestations may simulate an inflammatory syndrome of immune restoration. The authors report a case of multifocal tuberculosis developing approximately three months following the ARV treatment, with the aim of contributing to a better management of tuberculosis-HIV coinfection. It is a 45-year-old patient tested positive for HIV1 and placed on Atripla since May 07, 2015 with a CD4 T cell rate of 302 cells/mm3. She was admitted on July 7, 2015 in the Department of Infectious Diseases for chronic cough and alteration of general condition in whom multifocal tuberculosis (pulmonary, pleural and peritoneal) was diagnosed with a TCD4 lymphocyte fallen down to 147 cells/mm3. The interview indicated a good adherence to antiretroviral therapy. Placed under a tuberculosis quadritherapy, the evolution was favorable and she left the hospital on August 10, 2015. Tuberculosis developing three months after initiation of antiretroviral therapy is not always a manifestation of immune restoration syndrome. The accompanying TCD4 lymphopenia is often transitional and does not require a change in antiretroviral therapy.