RESUMO
Immune reconstitution inflammatory syndrome is an inflammatory reaction in HIV-infected patients after initiation of antiretroviral therapy resulting from restored immunity to specific infectious or non-infectious antigens. A 36-year-old male patient on highly active antiretroviral therapy of six months duration, presented with reddish, tender lesions over medial aspect of arm and a single, anaesthetic patch. Tender fluctuant swellings were seen on the medial aspect of left forearm. A few of them had ruptured spontaneously discharging pus. A skin biopsy from the anaesthetic patch showed caseating epitheloid granulomas. A diagnosis of Hansen's disease borderline tuberculoid in type 1 reversal reaction, with formation of nerve abscess due to Immune Reconstitution Inflammatory Syndrome was made. The patient was started on multibacillary multidrug therapy as per WHO guidelines and highly active antiretroviral therapy was continued.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/induzido quimicamente , Abscesso/tratamento farmacológico , Infecções por HIV/complicações , Hipersensibilidade/etiologia , Síndrome Inflamatória da Reconstituição Imune/complicações , Hanseníase Dimorfa/induzido quimicamente , Hanseníase Tuberculoide/induzido quimicamente , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Abscesso/etiologia , Adulto , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Biópsia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Humanos , Hipersensibilidade/diagnóstico , Hansenostáticos/uso terapêutico , Hanseníase Dimorfa/diagnóstico , Hanseníase Tuberculoide/diagnóstico , Masculino , Prednisolona/uso terapêutico , Pele/patologia , Resultado do TratamentoRESUMO
The human immunodeficiency virus (HIV) pandemic has disproportionately affected tropical regions of the world, where dermatoses, such as leprosy and leishmaniasis, rarely encountered in temperate climates, are endemic. Although the introduction of highly active antiretroviral therapy (HAART) has been lifesaving, a few patients undergoing HAART experience clinical deterioration caused by immune reconstitution inflammatory syndrome (IRIS). This article explores the range of tropical dermatoses that are reported to date with associated IRIS events.
Assuntos
Terapia Antirretroviral de Alta Atividade/efeitos adversos , Infecções por HIV/complicações , Síndrome Inflamatória da Reconstituição Imune/complicações , Dermatopatias/complicações , Dermatopatias/imunologia , Humanos , Leishmaniose/complicações , Leishmaniose/imunologia , Hanseníase/complicações , Hanseníase/imunologia , Micoses/microbiologia , Penicillium , Esporotricose/complicações , Esporotricose/imunologia , Estrongiloidíase/complicações , Clima TropicalRESUMO
Immune reconstitution inflammatory syndrome (IRIS) has become a frequent and potentially severe complication after initiation of following antiretroviral therapy (ART) in patients infected with human immunodeficiency virus (HIV). IRIS can unmask a previously clinically silent infection, such as tuberculosis, as recently described for Mycobacterium infections. We describe a case in a patient from Côte d'Ivoire living in France in whom skin papular lesions developed after initiation of ART. These lesions were associated with microbiologically proven leprosy. Thus, latent leprosy can appear as IRIS, and leprosy-associated IRIS should be considered in HIV-infected patients from areas endemic for leprosy.
Assuntos
Infecções por HIV/complicações , Síndrome Inflamatória da Reconstituição Imune/etiologia , Hanseníase/etiologia , Infecções por HIV/tratamento farmacológico , Humanos , Síndrome Inflamatória da Reconstituição Imune/complicações , Hanseníase/epidemiologiaAssuntos
Infecções Oportunistas Relacionadas com a AIDS/induzido quimicamente , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Síndrome Inflamatória da Reconstituição Imune/classificação , Síndrome Inflamatória da Reconstituição Imune/complicações , Hanseníase/complicações , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Adulto , Feminino , Humanos , Síndrome Inflamatória da Reconstituição Imune/imunologia , Hanseníase/imunologia , Masculino , Pessoa de Meia-IdadeRESUMO
Several case reports have demonstrated that the immune reconstitution inflammatory syndrome induces reversal reaction in HIV and leprosy-coinfected patients. The present study describes 10 cases of immune reconstitution inflammatory-associated reversal reaction. The patients evolved satisfactorily despite presenting a more severe form of the disease and the fact that three required an additional use of corticoids. The present study, the largest case series published to date, demonstrates that leprosy reaction is a manifestation of immune reconstitution.
Assuntos
Síndrome Inflamatória da Reconstituição Imune/complicações , Hanseníase/complicações , Adulto , Terapia Antirretroviral de Alta Atividade , Estudos de Coortes , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Humanos , Síndrome Inflamatória da Reconstituição Imune/imunologia , Hanseníase/imunologia , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
BACKGROUND: Immune reconstitution inflammatory syndrome (IRIS) is a paradoxical deterioration in clinical status in a patient on antiretroviral treatment (ART) despite satisfactory control of viral replication and improvement of CD4 count. AIM: To study development of IRIS as a part of ART. METHODS: Hundred patients on antiretroviral treatment were studied prospectively in the Department of Skin and VD over a period of 2 years. Patients were asked to come if they developed any symptoms or on a monthly basis. They were screened clinically and investigated suitably for evidence of opportunistic infections. RESULTS: Out of 100 patients, 10 patients did not come for follow-up. Twenty (22.2%) out of the 90 patients developed IRIS. Herpes zoster (HZ), herpes simplex virus (HSV), and tuberculosis (TB) were the cases of IRIS seen in the present study. CONCLUSIONS: IRIS in terms of HSV/TB is known to accelerate HIV disease progression. Hence early detection and prompt treatment, along with continuation of highly active ART, are of utmost importance.