SHM Converge Scientific Abstract ePoster Gallery-Unmasking Tb and Iris: More Than a Simple Pneumonia in an Immunosuppressed Patient

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This case report describes a 38-year-old woman with Crohn’s disease treated with infliximab who presented with fever, cough, and shortness of breath that did not improve with levofloxacin for presumed community-acquired pneumonia. Chest CT angiography showed a large mediastinal mass encasing the left upper lobe bronchus with post-obstructive pneumonia. Because she had emigrated from Ecuador and worked in healthcare, tuberculosis was considered; her QuantiFERON-TB test was newly positive, and bronchoscopy revealed granulomas and acid-fast bacilli PCR-positive for Mycobacterium tuberculosis. Infliximab was stopped, and she was started on standard four-drug anti-tuberculosis therapy.<br /><br />Twenty-five days later, she returned with worsening symptoms. Repeat chest CT showed increasing necrotic, mass-like consolidation and confluent lymphadenopathy. This was felt to represent tuberculosis-associated immune reconstitution inflammatory syndrome (IRIS), a paradoxical inflammatory worsening that can occur after immune function begins to recover, especially after withdrawal of TNF-alpha inhibitors. Corticosteroids were started, leading to clinical improvement.<br /><br />The report emphasizes that tuberculosis can mimic pneumonia or malignancy, particularly in immunosuppressed patients and those with epidemiologic risk factors. It also highlights the importance of recognizing IRIS as inflammation rather than treatment failure or progressive infection. Early suspicion, appropriate diagnostic testing, and timely use of corticosteroids when indicated can improve outcomes.

Asset Subtitle

Karen Go

Meta Tag

Author List Hong Yu Wang, Karen Go, Patricia Dharapak

Category Clinical Vignettes

Concept Tuberculosis

Concept Immune Reconstitution Inflammatory Syndrome

Concept Anti-tuberculosis Regimen

Concept Immunosuppression

Concept Treatment Failure

Distinguished Non-Finalist

Presenter Organization Mount Sinai West and Morningside

Presenting Author Karen Go

Track Adult

Keywords

Crohn’s disease

infliximab

tuberculosis

mediastinal mass

post-obstructive pneumonia

acid-fast bacilli

immune reconstitution inflammatory syndrome

corticosteroids

granulomas

TNF-alpha inhibitors

Tuberculosis

Immune Reconstitution Inflammatory Syndrome

Anti-tuberculosis Regimen

Immunosuppression

Treatment Failure