Paralytic Ileus during Treatment of Pulmonary and Renal Tuberculosis in a Non-Human Immunodeficiency Virus Patient: An Unusual Presentation of Tuberculosis-immune Reconstitution Inflammatory Syndrome

Toyohiro Hashiba; Mai Sugahara; Yui Ota; Ken Kaseda; Yusuke Kashiwagi; Motonobu Nakamura; Takayuki Shinohara; Mahoko Ikeda; Shu Okugawa; Kazuma Sugimoto; Kenichi Sasaki; Yoshifumi Hamasaki; Daisuke Yamada; Haruki Kume; Kyoji Moriya; Masaomi Nangaku

doi:10.2169/internalmedicine.0898-22

CASE REPORTS

Paralytic Ileus during Treatment of Pulmonary and Renal Tuberculosis in a Non-Human Immunodeficiency Virus Patient: An Unusual Presentation of Tuberculosis-immune Reconstitution Inflammatory Syndrome

Toyohiro Hashiba, Mai Sugahara, Yui Ota, Ken Kaseda, Yusuke Kashiwagi, Motonobu Nakamura, Takayuki Shinohara, Mahoko Ikeda, Shu Okugawa, Kazuma Sugimoto, Kenichi Sasaki, Yoshifumi Hamasaki, Daisuke Yamada, Haruki Kume, Kyoji Moriya, Masaomi Nangaku

Author information

Toyohiro Hashiba
Division of Nephrology and Endocrinology, the University of Tokyo Hospital, Japan
Mai Sugahara
Division of Nephrology and Endocrinology, the University of Tokyo Hospital, Japan
Yui Ota
Division of Nephrology and Endocrinology, the University of Tokyo Hospital, Japan
Ken Kaseda
Division of Nephrology and Endocrinology, the University of Tokyo Hospital, Japan
Yusuke Kashiwagi
Division of Nephrology and Endocrinology, the University of Tokyo Hospital, Japan
Motonobu Nakamura
Division of Nephrology and Endocrinology, the University of Tokyo Hospital, Japan
Takayuki Shinohara
Department of Infectious Diseases, the University of Tokyo Hospital, Japan
Mahoko Ikeda
Department of Infectious Diseases, the University of Tokyo Hospital, Japan
Shu Okugawa
Department of Infectious Diseases, the University of Tokyo Hospital, Japan
Kazuma Sugimoto
Department of Urology, the University of Tokyo Hospital, Japan
Kenichi Sasaki
Department of Urology, the University of Tokyo Hospital, Japan
Yoshifumi Hamasaki
Department of Hemodialysis & Apheresis, the University of Tokyo Hospital, Japan
Daisuke Yamada
Department of Urology, the University of Tokyo Hospital, Japan
Department of Hemodialysis & Apheresis, the University of Tokyo Hospital, Japan
Haruki Kume
Department of Urology, the University of Tokyo Hospital, Japan
Kyoji Moriya
Department of Infectious Diseases, the University of Tokyo Hospital, Japan
Masaomi Nangaku
Division of Nephrology and Endocrinology, the University of Tokyo Hospital, Japan
Department of Hemodialysis & Apheresis, the University of Tokyo Hospital, Japan

Keywords: abdominal symptoms, hemodialysis, paralytic ileus, steroids, tuberculosis, tuberculosis-immune reconstitution inflammatory syndrome

JOURNAL OPEN ACCESS

2023 Volume 62 Issue 17 Pages 2559-2564

DOI https://doi.org/10.2169/internalmedicine.0898-22

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Abstract

Paralytic ileus as tuberculosis-immune reconstitution inflammatory syndrome (TB-IRIS) is extremely rare. We herein report a 44-year-old man with pulmonary and renal tuberculosis who developed paralytic ileus 14 days after starting antituberculosis therapy (ATT) despite an initial favorable response to ATT. Paralytic ileus was successfully managed with conservative care. He initially required hemodialysis because of obstructive uropathy due to renal tuberculosis, but he was able to withdraw from dialysis after placement of ureteral stents. TB-IRIS can affect organs other than the original sites of tuberculosis, and the combined use of steroids may be effective for its prevention and treatment.

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