IRIS in a person living with HIV due to disseminated Mycobacterium simiae infection possibly acquired after a remote travel history to Thailand

Abstract

We report a case of a man living with HIV with a baseline CD4 count of 7 cells/μl, who initially presented with vision loss due to CMV retinitis and cervical lymphadenopathy. Upon initiating antiretroviral therapy, his lymph node swelling increased, and a biopsy culture grew Mycobacterium simiae. The patient had a remote history of travel to Thailand, where he had frequent close encounters with monkeys. Primates may harbour non-tuberculous mycobacteria (NTM), and zoonotic transmission from monkeys to humans is feasible. Despite antimicrobial therapy, his condition worsened with increased lymph node swelling and abscess formation, which required surgical drainage, and he was determined to have developed immune reconstitution inflammatory syndrome (IRIS). Corticosteroid therapy was started, which showed a quick clinical response.