Acute Respiratory Distress Syndrome as a paradoxical response to anti-tuberculosis and anti-retroviral therapy.

Paradoxical response or immune reconstitution inflammatory syndrome (IRIS) during the course of antituberculous therapy is being increasingly recognised among patients with and without HIV co-infection. A 40-year-old HIV infected male on anti-retroviral therapy (ART) presented with persistent fever and weight loss. He was diagnosed to have miliary tuberculosis and HIV co-infection. Following initiation of anti-tuberculous chemotherapy, the clinical course was characterised by development of acute respiratory failure (ARDS) as a paradoxical response/IRIS to treatment. This uncommon manifestation of paradoxical response (ARDS) in HIV and tuberculous co-infection following initiation of ART and anti-TB treatment is very scarcely reported in the past. With the increasing incidence of HIV/AIDS and TB co-infection along with liberal access to ART in the developing world, it is likely that paradoxical reactions will be encountered more frequently.