Immune reconstitution inflammatory syndrome presenting as genital ulcers due to herpes simplex virus: A case report

Abstract Immune reconstitution inflammatory syndrome (IRIS) is a collection of inflammatory disorders characterized by the paradoxical worsening of preexisting infections processes following the initiation of antiretroviral therapy in human immunodeficiency virus (HIV)-infected individuals. Diagnosing IRIS accurately and promptly remains challenging in areas with limited medical resources. Herpes simplex virus-2 (HSV-2) is highly endemic in sub-Saharan Africa and is one of the primary opportunistic pathogens underlying IRIS, manifesting as mucocutaneous lesions. Here, we report a case of HSV-2-associated IRIS presenting as a genital ulcer, confirmed through nanopore high-throughput sequencing and successfully treated with acyclovir antiviral therapy. This study emphasizes the importance of clinicians maintaining proficiency in recognizing IRIS manifestations and being aware of region-specific opportunistic pathogens, both essential for timely diagnosis and etiology-directed therapy.