Immune Reconstitution Inflammatory Syndrome Presenting as Mycobacterium avium Complex Cervical Lymphadenitis and Mycobacterium kansasii Pulmonary Disease in an HIV-Infected Patient

Abstract Immune reconstitution syndrome (IRIS) is a known complication from antiretroviral therapy that can occur in response to a pathogen, host, and/or treatment factors. Its presentation is heterogeneous and can pose a significant treatment challenge. Opportunistic infections presenting as IRIS can occur under settings, such as immunosuppression secondary to tumor necrosis factor inhibitors, untreated HIV starting antiretroviral therapy, hematopoietic stem cell, and solid organ transplant once immunosuppression is removed ( HIV AIDS (Auckl) . 2015;7:49–64). The most common nontuberculous mycobacteria (NTM) to cause disease in advanced HIV is Mycobacterium avium complex. This pathogen can manifest during IRIS-causing focal disease, presenting as localized lymphadenopathy, or disseminated disease, with constitutional symptoms ( Clin Microbiol Rev. 1996;9(2):177–215). Mycobacterium kansasii is the second most common NTM, to affect the lungs, and can also cause disseminated disease. We present a case of IRIS in an HIV-1–infected patient with evidence of 2 NTM-causing diseases.