CASE REPORT Drug rash vs. immune reconstitution inflammatory syndrome (IRIS)–a diagnostic dilemma N. Gupta, A. Mittal and N. Nischal From the Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110049, Delhi, India Address correspondence to Dr N. Nischal, Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110049, Delhi, India. email: neerajnischal@gmail.com Learning point for clinicians  Not all rashes that appear after initiation of anti- retroviral therapy are drug rashes, immune reconstitu- tion inflammatory syndrome (IRIS) is a very close mimic. Failing to diagnose IRIS in such situations will not only lead to unnecessary withdrawal of essential drugs, but will also cause considerable morbidity. Introduction Immune reconstitution inflammatory syndrome (IRIS) is a paradoxical worsening of a known clinical condition or the appearance of a new disease after initiating anti-retroviral therapy (ART). Dermatological IRIS usually occurs within 24 weeks of initiation. 1 Dermatological lesions are often con- fused with drug rash as they both appear shortly after initi- ation of drugs. Figure 1. (a) Generalized papular eruptions all over body including the genitals. (b) Vesicular lesions over left upper limb. Received: 2 August 2019; Revised (in revised form): 6 August 2019 V C The Author(s) 2019. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For permissions, please email: journals.permissions@oup.com 1 QJM: An International Journal of Medicine, 2019, 1–2 doi: 10.1093/qjmed/hcz214 Advance Access Publication Date: 10 August 2019 Case report Downloaded from https://academic.oup.com/qjmed/advance-article-abstract/doi/10.1093/qjmed/hcz214/5545980 by guest on 26 August 2019