Basic and Clinical Sciences (BCSE) Practice Exam

The characteristic feature of TB-IRIS (Tuberculosis-Immune Reconstitution Inflammatory Syndrome) in patients with tuberculosis is the worsening of symptoms after the initiation of antiretroviral therapy (ART). This phenomenon occurs in individuals with a history of tuberculosis who have a compromised immune system, typically those co-infected with HIV. When ART is started, the immune system begins to recover, which can lead to an exaggerated inflammatory response against the residual TB antigens, resulting in the worsening of tuberculosis-related symptoms.

This worsening can manifest as fever, lymphadenopathy, or pulmonary symptoms, despite the fact that the overall infection may be improving due to effective anti-TB treatment. The body's immune response becomes hyperactive, leading to an inflammatory reaction that can complicate the clinical picture.

Other options do not accurately represent TB-IRIS because they suggest an improvement or do not align with the typical clinical timeline associated with this syndrome. For example, general symptom improvement or symptom recurrence after a specific period does not describe the acute worsening directly linked to ART initiation in TB-IRIS cases.