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1.
BMC Infect Dis ; 20(1): 15, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31906936

RESUMO

BACKGROUND: Bacillus cereus sometimes causes central nervous system infection, especially in compromised hosts. In cases of meningitis arising during neutropenia, CSF abnormalities tend to be subtle and can be easily overlooked, and mortality rate is high. We report a survived case of B. cereus meningitis/brain abscess in severe neutropenia, presenting as immune reconstitution syndrome. CASE PRESENTATION: A 54-year-old Japanese female with acute myelogenous leukemia developed B. cereus bacteremia and meningitis during consolidation chemotherapy. At the onset, she presented with mild meningism. She had marked leukocytopenia (WBC <100/µL, neutrophils 0/µL) and lumbar puncture yielded only mild pleocytosis. She was transferred to intensive care unit, and meropenem, linezolid and vancomycin was started. With intensive therapy, she recovered and once became afebrile. On day 19, however, her fever, meningism and consciousness level dramatically worsened despite recovery of bone marrow function. The antimicrobial chemotherapy was continued and finally she was cured with no complications. CONCLUSIONS: With early diagnosis and prompt initiation and of antibiotics, the case was successfully treated without any sequelae. It is important to remember that, even under optimal antimicrobial therapy, bone marrow recovery can cause transient reaggravation of the disease. In such cases, timely and appropriate evaluation should be done to make the clinical decision to change, continue, or intensify treatment.


Assuntos
Bacteriemia/complicações , Abscesso Encefálico/complicações , Neutropenia Febril Induzida por Quimioterapia/complicações , Síndrome Inflamatória da Reconstituição Imune/complicações , Meningites Bacterianas/complicações , Antibacterianos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bacillus cereus/isolamento & purificação , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/microbiologia , Feminino , Humanos , Síndrome Inflamatória da Reconstituição Imune/tratamento farmacológico , Síndrome Inflamatória da Reconstituição Imune/microbiologia , Leucemia Mieloide Aguda/tratamento farmacológico , Meningites Bacterianas/tratamento farmacológico , Meningites Bacterianas/microbiologia , Pessoa de Meia-Idade , Resultado do Tratamento
2.
Medicine (Baltimore) ; 98(49): e18163, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804330

RESUMO

RATIONALE: Non-traumatic bowel perforation caused by cytomegalovirus (CMV) and Mycobacterium avium complex (MAC) infections has become rare among patients with acquired immunodeficiency syndrome (AIDS) in the era of combination antiretroviral therapy (cART); however, CMV-associated and MAC-related immune reconstitution inflammatory syndrome (IRIS) has subsequently emerged owing to the wide use of integrase inhibitor-based regimens. Here we report a case of spontaneous perforation of the jejunum in a patient with human immunodeficiency virus (HIV) infection with good compliance to cART. PATIENT CONCERNS: A 32-year-old HIV-infected man developed CMV disease and DMAC infection, as unmasking IRIS, 3 days after the initiation of cART. After appropriate treatment for opportunistic infections, intermittent fever with enlarged lymph nodes in the abdomen occurred as paradoxical IRIS. The patient was administered prednisolone with subsequent tapering according to his clinical condition. DIAGNOSES: Unexpected perforation of hollow organ during the titration of steroid dose with clinical presentations of severe abdominal pain was diagnosed by chest radiography. INTERVENTIONS: He underwent surgical repair with peritoneal toileting smoothly. OUTCOMES: He was discharged well with a clean surgical wound on post-operative day 10. LESSONS: Bowel perforation may be a life-threatening manifestation of IRIS in the era of cART. Steroids should be avoided, if possible, to decrease the risk of bowel perforation, especially in IRIS occurred after opportunistic diseases involving the gastrointestinal tract.


Assuntos
Infecções por Citomegalovirus/complicações , Infecções por HIV/complicações , Síndrome Inflamatória da Reconstituição Imune/complicações , Perfuração Intestinal/etiologia , Doenças do Jejuno/etiologia , Infecção por Mycobacterium avium-intracellulare/complicações , Infecções Oportunistas Relacionadas com a AIDS , Adulto , Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Humanos , Masculino
4.
Transpl Infect Dis ; 21(5): e13162, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31419376

RESUMO

Progressive multifocal leukoencephalopathy (PML) is a life-threatening central nervous system (CNS) disorder, most commonly described in patients infected with the human immunodeficiency virus (HIV). Limited data exist on its natural history and treatment in solid organ transplant (SOT) recipients. A complication of PML is the immune reconstitution inflammatory syndrome (IRIS), which develops after T cell reconstitution and can have severe consequences when it occurs in the CNS. While well described in HIV-infected individuals, its clinical features, diagnosis, and treatment after SOT are largely unknown. We report a case of a kidney transplant recipient who was diagnosed with PML and developed significant worsening of her symptoms upon reduction of immunosuppression. Thallium SPECT showed avid uptake suggestive of lymphoma, but the diagnosis of PML-IRIS was ultimately established by brain biopsy. She survived with nearly complete restoration of her functional status after a prolonged steroid taper.


Assuntos
Síndrome Inflamatória da Reconstituição Imune/complicações , Síndrome Inflamatória da Reconstituição Imune/diagnóstico por imagem , Transplante de Rim/efeitos adversos , Leucoencefalopatia Multifocal Progressiva/complicações , Leucoencefalopatia Multifocal Progressiva/diagnóstico por imagem , Biópsia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Feminino , Humanos , Imunossupressão , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Inteligibilidade da Fala
5.
PLoS One ; 14(4): e0215991, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31022273

RESUMO

BACKGROUND: Tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is an inflammatory complication in HIV-TB co-infected patients receiving antiretroviral therapy (ART). The exact contribution of T cells, natural killer (NK) cells, and monocytes to TB-IRIS development remains unclear. Here, we studied the expression of exhaustion markers on lymphocytes at different intervals during ART. METHODS: We compared 13 HIV-TB patients who developed TB-IRIS with 13 patients who did not (HIV+TB+), 13 HIV-patients without TB (HIV+TB-) and 9 HIV/TB-negative controls (HIV-TB-). Patients did not differ in age, gender, or CD4-count prior to ART. Frozen peripheral blood mononuclear cells, collected before ART and during 3 months and 9 months of ART, were analysed using flow cytometry. We examined expression of KLRG1, PD-1 and IL-27R on CD4+ and CD8hi T cells, as well as CD3-negative CD8lo lymphocytes as an approximate subset of NK cells. In addition, expression of TLR2, TLR4, IL1RL1, and TRAILR on CD14+ monocytes were investigated. RESULTS: Prior to ART, TB-IRIS patients had higher percentages of CD8hi T cells that are KLRG1+PD-1+ compared to each control group (p≤0.034). Though PD-1 expression decreased during ART in all groups (p≤0.026), the percentage KLRG1+PD-1+CD8hi T cells remained higher in TB-IRIS patients after 3 months of ART (p≤0.013). Though these patterns were less pronounced in CD3-CD8lo lymphocytes, the percentage of KLRG1+ cells was higher in TB-IRIS patients prior to ART (p≤0.043). In contrast, no clear differences could be observed for CD4+ T cells or monocytes. CONCLUSION: TB-IRIS is preceded by a high level of exhausted (KLRG1+PD-1+) CD8hi T cells, which persists during 3 months of ART. This trait is potentially mirrored in a subpopulation of NK cells, but not CD4+ T cells. Since a dysfunctional CD8+ lymphocyte compartment could predispose patients to TB-IRIS, the functional role of these cells prior to TB-IRIS development should be further explored.


Assuntos
Linfócitos T CD8-Positivos/metabolismo , Síndrome Inflamatória da Reconstituição Imune/complicações , Síndrome Inflamatória da Reconstituição Imune/imunologia , Lectinas Tipo C/metabolismo , Receptor de Morte Celular Programada 1/metabolismo , Receptores Imunológicos/metabolismo , Tuberculose/complicações , Tuberculose/imunologia , Adulto , Biomarcadores/metabolismo , Linfócitos T CD4-Positivos/imunologia , Estudos de Casos e Controles , Feminino , Humanos , Memória Imunológica , Masculino , Receptores de Interleucina/metabolismo , Receptores Toll-Like/metabolismo
6.
Int J STD AIDS ; 30(5): 509-511, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30999832

RESUMO

The presentation of syphilis as a manifestation of immune reconstitution inflammatory syndrome in patients with human immunodeficiency virus (HIV) infection is rare and can be associated with the varied clinical expression of unusual syphilitic manifestations. We report a case of immune reconstitution syndrome with dermatologic, ophthalmologic and neurologic compromise of secondary syphilis in a patient with HIV infection.


Assuntos
Infecções por HIV/complicações , Síndrome Inflamatória da Reconstituição Imune/diagnóstico , Sífilis/diagnóstico , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Alopecia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Soropositividade para HIV/complicações , Humanos , Síndrome Inflamatória da Reconstituição Imune/complicações , Síndrome Inflamatória da Reconstituição Imune/tratamento farmacológico , Síndrome Inflamatória da Reconstituição Imune/imunologia , Masculino , Pan-Uveíte , Penicilinas/administração & dosagem , Penicilinas/uso terapêutico , Sífilis/complicações , Sífilis/tratamento farmacológico , Resultado do Tratamento , Adulto Jovem
8.
Retin Cases Brief Rep ; 13(3): 207-210, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-28333858

RESUMO

PURPOSE: To report an human immunodeficiency virus-positive patient undergoing therapy for cryptococcal meningitis who developed progressive optic disk edema that was steroid responsive. METHODS: Observational case report. RESULTS: One month after commencing antifungal treatment for cryptococcal meningitis, the patient developed bilateral, progressive, recurrent optic disk edema with subretinal fluid that coincided with initiation of highly active antiretroviral therapy and recovery of CD4 cell counts. Lumbar puncture revealed normal opening pressure, and cerebrospinal fluid showed no recurrence of cryptococcal infection. There was no evidence of uveitis. The patient rapidly improved with a 5-day course of high-dose intravenous methylprednisolone. CONCLUSION: Recurrent optic disk edema with loss of vision after treatment of cryptococcal meningitis in the setting of normal intracranial pressure may represent a unique manifestation of immune reconstitution inflammatory syndrome localized to the optic nerve without uveitis. This is consistent with the temporal relationship between starting highly active antiretroviral therapy, CD4 count recovery, and the development of progressive disk edema in the study patient. Isolated optic nerve inflammation as a manifestation of immune reconstitution inflammatory syndrome has not been widely reported.


Assuntos
Síndrome Inflamatória da Reconstituição Imune/complicações , Meningite Criptocócica/complicações , Neurite Óptica/etiologia , Anti-Inflamatórios/uso terapêutico , Feminino , Humanos , Metilprednisolona/uso terapêutico , Neurite Óptica/tratamento farmacológico , Resultado do Tratamento , Adulto Jovem
9.
BMC Infect Dis ; 18(1): 520, 2018 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-30326861

RESUMO

BACKGROUND: Cryptococcal meningitis remains the leading cause of adult meningitis in Sub-Saharan Africa. Immune Reconstitution Inflammatory Syndrome (IRIS) following anti-retroviral therapy (ART) initiation is an important complication. Here we report the first documented case of a IRIS reaction presenting as an ischemic stroke. CASE PRESENTATION: A 38 year old newly diagnosed HIV-infected, ART naive Malawian male presented to a tertiary referral hospital in Blantyre, Malawi with a 2 week history of headache. A diagnosis of cryptococcal meningitis was made and the patient was started on 1200 mg fluconazole once daily and flucytosine 25 mg/kg four times daily as part of the Advancing Cryptococcal Treatment for Africa (ACTA) clinical trial. There was an initial clinical and microbiological response to anti-fungal treatment and anti-retroviral therapy was started at week 4. The patient re-presented 16 days later with recurrence of headache, fever, and a sudden onset of left sided weakness in the context of rapid immune reconstitution; peripheral CD4 count had increased from a baseline of 29 cells/µl to 198 cells/µl. Recurrence of cryptococcal meningitis was excluded through CSF examination and fungal culture. Magnetic Resonance Imaging (MRI) of the brain demonstrated multi-focal DWI (diffusion weighted imaging) positive lesions consistent with an ischemic stroke. Given the temporal relationship to ART initiation, these MRI findings in the context of sterile CSF with raised CSF protein and a rapid immune reconstitution, following an earlier favorable response to treatment is most consistent with a paradoxical Immune Reconstitution Inflammatory Syndrome. CONCLUSIONS: Stroke is an increasing cause of morbidity and mortality amongst HIV infected persons. Ischemic stroke is a recognized complication of cryptococcal meningitis in the acute phase and is thought to be mediated by an infectious vasculitis. This is the first time an ischemic stroke has been described as part of a paradoxical IRIS reaction. This report adds to the spectrum of clinical IRIS presentations recognized and highlights to clinicians the potential complications encountered at ART initiation in severely immunocompromised patients.


Assuntos
Isquemia Encefálica/etiologia , Síndrome Inflamatória da Reconstituição Imune/complicações , Meningite Criptocócica/complicações , Acidente Vascular Cerebral/etiologia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/patologia , Adulto , Antifúngicos/uso terapêutico , Isquemia Encefálica/patologia , Cryptococcus neoformans/imunologia , Cryptococcus neoformans/isolamento & purificação , Fluconazol/uso terapêutico , Flucitosina/uso terapêutico , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/patologia , Humanos , Síndrome Inflamatória da Reconstituição Imune/diagnóstico , Síndrome Inflamatória da Reconstituição Imune/patologia , Hospedeiro Imunocomprometido , Malaui , Masculino , Meningite Criptocócica/diagnóstico , Meningite Criptocócica/patologia , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/patologia
11.
Int J STD AIDS ; 29(14): 1451-1453, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30114992

RESUMO

Although Pneumocystis jiroveci pneumonia (PCP) is a frequent manifestation of acquired immune deficiency syndrome (AIDS), the granulomatous form is uncommon. Here, we present an unusual case of granulomatous PCP consequent to immune reconstitution inflammatory syndrome (IRIS) after highly active antiretroviral therapy. A 36-year-old woman with human immunodeficiency virus (HIV) presented with cough and dyspnea that were attributed to typical PCP associated with AIDS. She was successfully treated with antibiotic, steroid, and antiretroviral therapies. After six months, however, she presented with consolidating lung lesions caused by bronchial obstruction from PCP granulomatous disease. Although antibiotics were ineffective, the effectiveness of steroid therapy suggested a diagnosis of granulomatous IRIS caused by persistent PCP antigens. Physicians should strongly suspect PCP in HIV-positive patients with nodular lung lesions and must remain aware that these lesions, if immune in origin, might not respond to antimicrobial therapy.


Assuntos
Terapia Antirretroviral de Alta Atividade/efeitos adversos , Granuloma do Sistema Respiratório/diagnóstico , Infecções por HIV/tratamento farmacológico , Síndrome Inflamatória da Reconstituição Imune/complicações , Pulmão/diagnóstico por imagem , Pneumocystis carinii/isolamento & purificação , Pneumonia por Pneumocystis/diagnóstico , Adulto , Anti-Infecciosos Urinários/uso terapêutico , Broncoscopia , Feminino , Granuloma do Sistema Respiratório/complicações , Infecções por HIV/complicações , Infecções por HIV/microbiologia , Humanos , Síndrome Inflamatória da Reconstituição Imune/tratamento farmacológico , Hospedeiro Imunocomprometido , Pneumocystis carinii/imunologia , Pneumonia por Pneumocystis/tratamento farmacológico , Prednisona/uso terapêutico , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol
12.
Dermatol Online J ; 24(6)2018 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-30142721

RESUMO

The abrupt development of multiple melanocytic nevi has been described in association with many conditions, including human immunodeficiency virus infection. We report three cases of eruptive nevi in men with human immunodeficiency virus type 1 infection. One patient developed this phenomenon during the stage of acquired immunodeficiency syndrome. The other two patients had human immunodeficiency virus infection recently diagnosed and presented to our clinic reporting the development of multiple melanocytic nevi after starting highly active antiretroviral treatment, with improvement of their immunity. To our knowledge, this is the first report of eruptive melanocytic nevi as a possible consequence of the immune reconstitution inflammatory syndrome.


Assuntos
Terapia Antirretroviral de Alta Atividade/efeitos adversos , Infecções por HIV/complicações , Síndrome Inflamatória da Reconstituição Imune/complicações , Nevo Pigmentado/etiologia , Neoplasias Cutâneas/etiologia , Síndrome de Imunodeficiência Adquirida/complicações , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Adulto , Infecções por HIV/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Adulto Jovem
13.
Int J STD AIDS ; 29(12): 1250-1254, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29749873

RESUMO

Cryptococcus neoformans is a ubiquitous encapsulated environmental yeast that can cause severe central nervous system disease, primarily in immune compromised hosts. In patients with AIDS, the spectrum of cryptococcal central nervous system disease includes meningitis, cystic lesions, and mass-like cryptococcomas. We report a fatal case of meningitis and cerebritis caused by C. neoformans in an AIDS patient refractory to multiple courses of liposomal amphotericin B despite immune recovery with antiretroviral therapy. This case highlights ongoing diagnostic and therapeutic challenges in the face of treatment failure for cryptococcal meningitis and reinforces the need for improved treatment approaches.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS , Encéfalo/diagnóstico por imagem , Cryptococcus neoformans/isolamento & purificação , Febre/etiologia , Infecções por HIV/diagnóstico , Síndrome Inflamatória da Reconstituição Imune/complicações , Meningite Criptocócica/diagnóstico , Anfotericina B/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Evolução Fatal , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Meningite Criptocócica/complicações , Meningite Criptocócica/tratamento farmacológico , Pessoa de Meia-Idade
15.
Int J STD AIDS ; 29(9): 929-932, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29466918

RESUMO

Studies have suggested that the incidence of multiple sclerosis (MS) in HIV-infected (HIV+) patients is lower than that of the general population. Here, we present a case of MS in an HIV+ patient with a relatively suppressed CD4 cell count who developed clinical and radiographic disease worsening in the setting of antiretroviral therapy (ART) initiation. A 47-year-old HIV+ woman (CD4 cell count 216 cells/µl) presented with decreased vision in her right eye. Magnetic resonance imaging (MRI) revealed optic nerve enhancement and open ring-enhancing lesions in the brain concerning for demyelinating disease. Cerebrospinal fluid was tested extensively for infection and malignancy with no abnormal findings. She received five days of intravenous methylprednisolone. Nine days later, she was restarted on ART. Three weeks later, she was readmitted with left eye vision loss and left hemiplegia (CD4 cell count 342 cells/µl). Repeat imaging showed multiple new enhancing lesions. Several cases have described severe MS relapses and unusually widespread demyelinating lesions on MRI after withdrawal of immunosuppressive drugs. We posit that the clinical and radiographic progression that occurred in our patient after initiation of ART represented an immune reconstitution response to ART. Caution may be warranted when initiating ART in HIV+ patients with suppressed CD4 cell count and active MS.


Assuntos
Fármacos Anti-HIV/efeitos adversos , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Síndrome Inflamatória da Reconstituição Imune/imunologia , Esclerose Múltipla/diagnóstico por imagem , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Fármacos Anti-HIV/uso terapêutico , Contagem de Linfócito CD4 , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Humanos , Síndrome Inflamatória da Reconstituição Imune/complicações , Síndrome Inflamatória da Reconstituição Imune/diagnóstico , Imagem por Ressonância Magnética , Pessoa de Meia-Idade
16.
BMJ Case Rep ; 20182018 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-29477993

RESUMO

Restoration of immune response by highly active antiretroviral therapy (HAART) effectively improved the overall prognosis of HIV infection. However, 25%-31.7% of patients experience paradoxical worsening of pre-existing infections or unmasking of subclinical infections after starting HAART therapy, which is termed as immune reconstitution inflammatory syndrome (IRIS). Acute granulomatous interstitial nephritis as a consequence of IRIS has never been reported with Mycobacteriumkansasiicoinfection. Here, we describe an HIV/AIDS patient coinfected with disseminated M. kansasii infection, who presented with acute kidney injury 4.5 months after initiation of HAART. The diagnostic workup revealed IRIS was the cause of acute kidney injury. Short-term course of prednisone (1 mg/kg/day) along with antimycobacterial and HAART regimen achieved significant improvement.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Terapia Antirretroviral de Alta Atividade , Coinfecção/complicações , Infecções por HIV/complicações , Síndrome Inflamatória da Reconstituição Imune/complicações , Infecções por Micobactéria não Tuberculosa/complicações , Nefrite Intersticial/complicações , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Doença Aguda , Lesão Renal Aguda/complicações , Lesão Renal Aguda/tratamento farmacológico , Anti-Inflamatórios/uso terapêutico , Coinfecção/tratamento farmacológico , Diagnóstico Diferencial , Infecções por HIV/tratamento farmacológico , Humanos , Síndrome Inflamatória da Reconstituição Imune/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Infecções por Micobactéria não Tuberculosa/tratamento farmacológico , Mycobacterium kansasii/isolamento & purificação , Nefrite Intersticial/tratamento farmacológico , Prednisona/uso terapêutico
17.
BMJ Case Rep ; 20182018 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-29301795

RESUMO

Cytomegalovirus (CMV) colitis usually occurs in patients with advanced immunosuppression when the CD4 count is <50 cells/µL. We reported a case of recurrent CMV colitis in a patient with HIV who presented with profuse lower gastrointestinal bleed. This was a case of immune reconstitution inflammatory syndrome (IRIS) manifesting as CMV colitis and has been reported only once in the literature previously. This patient had a CD4 count of 157 cells/µL and undetectable viral load after being on antiretroviral therapy (ART) for 5 months, which was consistent with IRIS. The diagnosis of CMV was confirmed by a colonoscopy and a biopsy. This case highlights the fact that CMV colitis can manifest despite a moderately preserved CD4 count and the clinicians must have a high index suspicion for IRIS syndrome especially when someone was recently started on ART. Since effective treatment is available, it is important not to miss the diagnosis of CMV colitis.


Assuntos
Colite/virologia , Infecções por Citomegalovirus/complicações , Hemorragia Gastrointestinal/virologia , Infecções por HIV/complicações , Síndrome Inflamatória da Reconstituição Imune/complicações , Citomegalovirus , Infecções por Citomegalovirus/virologia , Feminino , Infecções por HIV/virologia , Humanos , Síndrome Inflamatória da Reconstituição Imune/virologia , Pessoa de Meia-Idade , Recidiva
18.
Int J STD AIDS ; 29(8): 834-836, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29361886

RESUMO

Immune reconstitution inflammatory syndrome (IRIS) in HIV-infected patients after initiating antiretroviral therapy usually involves worsening manifestations of overt infectious disease. Here, we describe a sporadic case of a late-diagnosed HIV-positive man who developed Graves' disease as the first noninfectious IRIS followed by immune thrombocytopenic purpura as the second noninfectious IRIS.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/induzido quimicamente , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Linfócitos T CD4-Positivos/imunologia , Doença de Graves/imunologia , Infecções por HIV/complicações , Síndrome Inflamatória da Reconstituição Imune/induzido quimicamente , Síndrome Inflamatória da Reconstituição Imune/imunologia , Púrpura Trombocitopênica Idiopática/imunologia , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Idoso , Antirretrovirais/uso terapêutico , Contagem de Linfócito CD4 , Doença de Graves/diagnóstico , Doença de Graves/tratamento farmacológico , HIV , Infecções por HIV/tratamento farmacológico , Humanos , Síndrome Inflamatória da Reconstituição Imune/complicações , Síndrome Inflamatória da Reconstituição Imune/patologia , Hospedeiro Imunocomprometido , Masculino , Metimazol/uso terapêutico , Púrpura Trombocitopênica Idiopática/diagnóstico , Púrpura Trombocitopênica Idiopática/tratamento farmacológico , Resultado do Tratamento
19.
J Neurol Neurosurg Psychiatry ; 89(5): 535-541, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29142146

RESUMO

BACKGROUND AND OBJECTIVE: Natalizumab-associated progressive multifocal leukoencephalopathy (NTZ-PML) patients may show imaging signs suggestive of inflammation at diagnosis ('inflammatory PML'), reminiscent of PML-immune reconstitution inflammatory syndrome (PML-IRIS). We investigated the imaging characteristics of inflammatory NTZ-PML lesions and PML-IRIS to determine differentiating and overlapping features. METHODS: We scored the presence, localisation and pattern of imaging characteristics of inflammation on brain MRI scans of inflammatory NTZ-PML patients. The imaging characteristics were followed up until the occurrence of PML-IRIS. RESULTS: Ten out of the 44 NTZ-PML patients included showed signs suggestive of inflammation at the time of diagnosis. The inflammation pattern at diagnosis was similar to the pattern seen at PML-IRIS, with contrast enhancement representing the most frequent sign of inflammation (90% at diagnosis, 100% at PML-IRIS). However, the severity of inflammation differed, with absence of swelling and low frequency of perilesional oedema (10%) at diagnosis, as compared with the PML-IRIS stage (40%). CONCLUSION: Patterns of inflammation at the time of PML diagnosis and at the PML-IRIS stage overlap but differ in their severity of inflammation. This supports histopathological evidence that the inflammation seen at both stages of the same disease shares a similar underlying pathophysiology, representing the immune response to the JC virus to a variable extend.


Assuntos
Síndrome Inflamatória da Reconstituição Imune/diagnóstico por imagem , Inflamação/diagnóstico por imagem , Leucoencefalopatia Multifocal Progressiva/diagnóstico por imagem , Natalizumab/efeitos adversos , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Síndrome Inflamatória da Reconstituição Imune/complicações , Fatores Imunológicos/efeitos adversos , Inflamação/induzido quimicamente , Inflamação/complicações , Leucoencefalopatia Multifocal Progressiva/induzido quimicamente , Leucoencefalopatia Multifocal Progressiva/complicações , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroimagem , Adulto Jovem
20.
J Dermatol ; 45(1): 3-9, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28944502

RESUMO

Immune reconstitution inflammatory syndrome (IRIS) represents a clinical phenomenon of immune-mediated inflammation against various antigens, including pathogenic microorganisms, drugs and unknown autoantigens, during recovery from immunosuppressed conditions. IRIS has become well recognized in HIV-infected populations. However, IRIS has seldom been recognized in HIV-negative immunocompromised patients. In the last 15 years, the immunopathogenesis of drug-induced hypersensitivity syndrome (DIHS) has been largely determined. Laboratory data and clinical observations support the idea that DIHS represents a prototype of non-HIV IRIS. Primary diseases in which non-HIV IRIS is secondary include severe cutaneous adverse drug reactions, such as DIHS, autoimmune diseases, collagen diseases, pregnancy and internal malignancies. Potential triggers of recovery from an immune deterioration state include a discontinuation or abrupt tapering of systemic steroids and/or immunosuppressants, withdrawal or reduced effects of anti-tumor necrosis factor-α antibodies, and the use of immune-checkpoint antagonists for the advanced stages of malignancies. Wide use of IRIS across large populations risks oversimplification but highlights a key unifying principle. Balanced sensitivity and specificity for its diagnostic criteria and classification are necessary for the establishment of clinical practice guidelines for non-HIV IRIS. Additionally, the development of a useful combination of biomarkers is currently an urgent issue.


Assuntos
Síndrome de Hipersensibilidade a Medicamentos/etiologia , Síndrome Inflamatória da Reconstituição Imune/complicações , Anticorpos Monoclonais/efeitos adversos , Gerenciamento Clínico , Síndrome de Hipersensibilidade a Medicamentos/diagnóstico , Feminino , Humanos , Síndrome Inflamatória da Reconstituição Imune/diagnóstico , Gravidez , Fator de Necrose Tumoral alfa/antagonistas & inibidores
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