CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 3, April 2012
AFRICA
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prior to ART and then recurrence of TB symptoms associated
with worsening of the pre-existing infiltrate of TB on the chest
radiograph soon after ART commencement. Secondly, the
patient had presented with severe acute heart failure four weeks
after starting ART, coincident with the development of TB-IRIS.
The cause of his heart failure was unclear and our considerations
regarding the aetiology are discussed below.
He was transferred to the high-care unit and commenced
on a dobutamine infusion, and once his blood pressure had
improved over the next few days, furosemide, enalapril and
Fig. 2. ECG on admission.
A
B
C
D
Fig. 1. Chest radiographs of the case: (A) at the time of initiation of ART he had a right middle lobe infiltrate ascribed
to pulmonary TB. (B) Four weeks later at the time of presentation with TB-IRIS and cardiogenic shock the infiltrate
had extended and there was a marked increase in cardiothoracic ratio (CTR). (C) Seven weeks on ART, when he was
clinically much improved, the infiltrate had decreased in size and the CTR had decreased. (D) Ten weeks on ART, when
TB-IRIS recurred after weaning prednisone, there was again an increase in the pulmonary infiltrate.
