Immunopathology: immune reconstitution inflammatory syndrome: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Immunopathology: immune reconstitution inflammatory syndrome

Sample item

A man with HIV and a CD4 count of 40 cells per microlitre is started on antiretroviral therapy. Six weeks later, with a rising CD4 count and falling viral load, he develops fever, new lymphadenopathy and worsening chest findings caused by previously subclinical tuberculosis. What is this phenomenon?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Immune reconstitution inflammatory syndrome

In IRIS the recovering immune system mounts an exaggerated inflammatory response to a pre-existing infection (often tuberculosis, cryptococcosis or CMV), unmasking or worsening it, usually in the first weeks to months of therapy. Treatment is of the infection with continued ART and sometimes steroids.

Option by option

  • A. Antiretroviral drug resistance

    Drug resistance would show rising viral load, not a falling one.

  • B. Graft-versus-host reaction

    GVHD requires donor lymphocytes and does not occur here.

  • C. Immune reconstitution inflammatory syndrome (correct)

    Correct. Restored immunity causes inflammation against an existing opportunistic infection.

  • D. Serum sickness

    Serum sickness is an immune complex reaction to foreign protein or drugs.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is C, Immune reconstitution inflammatory syndrome. In IRIS the recovering immune system mounts an exaggerated inflammatory response to a pre-existing infection (often tuberculosis, cryptococcosis or CMV), unmasking or worsening it, usually in the first weeks to months of therapy.

Why is "Antiretroviral drug resistance" not the answer?

Drug resistance would show rising viral load, not a falling one.

Why is "Graft-versus-host reaction" not the answer?

GVHD requires donor lymphocytes and does not occur here.

Why is "Serum sickness" not the answer?

Serum sickness is an immune complex reaction to foreign protein or drugs.

What concept does this question test?

It tests Immunopathology: immune reconstitution inflammatory syndrome in Pathology. Treatment is of the infection with continued ART and sometimes steroids.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Immunopathology: immune reconstitution inflammatory syndrome?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.