Background

In sub-Saharan Africa (SSA) central nervous system (CNS) infections in patients with HIV/AIDS are a major cause of HIV-related mortality and morbidity.

Case presentation

We describe a patient with a paraparesis after start of tuberculosis (TB) treatment. The patient had stage IV HIV and was not on antiretroviral therapy. Past history revealed two previous attempts to start TB treatment also complicated with the onset of bilateral lower limb weakness and numbness. MRI showed a cervical longitudinal transverse myelitis. LP showed slight inflammatory changes with positive GeneXpert, consistent with CNS TB. We made a diagnosis of central nervous system tuberculosis immune reconstitution inflammatory syndrome (CNS-TB IRIS) based on the history of recurring episodes of leg weakness after initiating TB treatment coupled with the confirmation of CNS TB.

Conclusion

IRIS is a complex disease spectrum and should be considered in immunosuppressed patients with new or worsening symptoms upon initiation of treatment for opportunistic infections, even in patients without antiretroviral therapy.