Immune mediated 'HAART' attack during treatment for tuberculosis

Highly active antiretroviral therapy (HAART) suppresses viral replication a nd improves immune function. However the inflammatory component of immune r estoration can have clinically deleterious effects on previously asymptomat ic infections. We report the development of acute respiratory failure in a patient after the institution of HAART, following 2 months of appropriate t herapy for pulmonary tuberculosis. Necrotizing granulomas with acid-fast ba cilli were found on lung biopsy, but cultures were negative for Mycobacteri um tuberculosis and no other pathogens were isolated. Polymerase chain reac tion of lung biopsy tissue for all mycobacterial species was positive only for M. tuberculosis. Rapid clinical improvement followed corticosteroid the rapy. After initiating HAART, clinicians should, be aware of the possibilit y of an inflammatory response to a previously quiescent tuberculous infecti on, even while on antituberculosis therapy.