Unmasking tuberculosis - Immune reconstitution inflammatory syndrome manifested as meningitis

Unmasking tuberculosis-immune reconstitution inflammatory syndrome (TB-IRIS) is an inflammatory reaction to HIV infection that is developed after antiretroviral therapy is initiated and a tuberculosis diagnosis is made within three months. We described a young male living with HIV who developed unmasking TB-IRIS, which manifested as tuberculous meningitis. Steroids and antitubercular treatment were initiated with a good clinical response, but the patient later developed acute respiratory distress syndrome. In the context of unmasking TB-IRIS, both entities are unusually concurrent. This case illustrates a rare but fatal complication that could develop in individuals living with HIV following antiretroviral and antitubercular treatment. • HIV-associated tuberculosis is frequent. • Antiretroviral therapy and antitubercular treatment are frequently prescribed. • Unmasking TB-IRIS is an inflammatory reaction to HIV after antiretroviral therapy. • Meningitis tuberculous and acute respiratory distress syndromes are uncommon.