Immune Reconstitution Inflammatory Syndrome: A Rare Cause of Pleural Effusion in Rifampicin Resistance Non-HIV TB Lymphadenitis Patient

The initiation of anti-tubercular treatment can trigger a pathological hyper-inflammatory response to viable or dead Mycobacterium tuberculosis, known as tuberculosis-immune reconstitution inflammatory syndrome (TB-IRIS).Tuberculosis immune reconstitution inflammatory syndrome has been extensively studied in HIV patients and is very rare in non-HIV patients.However, it can occur following corticosteroid withdrawal, discontinuation of anti-TNF therapy, or recovery from neutropenia in non-HIV patients.In non-HIV TB patients, TB-IRIS is particularly rare.The most common manifestation of TB-IRIS in cases of TB lymphadenitis is the development of new lymphadenopathy or the enlargement of pre-existing lymph nodes.Here, we report cases of rifampicin-resistant tubercular lymphadenitis with IRIS presenting with pleural effusion, which completely resolved following steroid therapy.