Immune Reconstitution Inflammatory Syndrome: Opening Pandora’s Box
One of the purposes of antiretroviral therapy (ART) is to restore the immune system. However, it can sometimes lead to an aberrant inflammatory response and paradoxical clinical worsening known as the immune reconstitution inflammatory syndrome (IRIS). We describe a 23-year-old male, HIV1 infected w...
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| Format: | Article |
| Language: | English |
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Wiley
2017-01-01
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| Series: | Case Reports in Infectious Diseases |
| Online Access: | http://dx.doi.org/10.1155/2017/5409254 |
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| author | Mariana Meireles Conceição Souto Moura Margarida França |
| author_facet | Mariana Meireles Conceição Souto Moura Margarida França |
| author_sort | Mariana Meireles |
| collection | DOAJ |
| description | One of the purposes of antiretroviral therapy (ART) is to restore the immune system. However, it can sometimes lead to an aberrant inflammatory response and paradoxical clinical worsening known as the immune reconstitution inflammatory syndrome (IRIS). We describe a 23-year-old male, HIV1 infected with a rapid progression phenotype, who started ART with TCD4+ of 53 cells/mm3 (3,3%) and HIV RNA = 890000 copies/mL (6 log). Four weeks later he was admitted to the intensive care unit with severe sepsis. The diagnostic pathway identified progressive multifocal leukoencephalopathy, digestive Kaposi sarcoma, and P. aeruginosa bacteraemia. Five weeks after starting ART, TCD4+ cell count was 259 cells/mm3 (15%) and HIV RNA = 3500 copies/mL (4 log). He developed respiratory failure and progressed to septic shock and death. Those complications might justify the outcome but its autopsy opened Pandora’s box: cerebral and cardiac toxoplasmosis was identified, as well as hemophagocytic syndrome, systemic candidiasis, and Mycobacterium avium complex infection. IRIS remains a concern and eventually a barrier to ART. Male gender, young age, low TCD4 cell count, and high viral load are risk factors. The high prevalence of subclinical opportunistic diseases highlights the need for new strategies to reduce IRIS incidence. |
| format | Article |
| id | doaj-art-5680ca8ec17a4a7b9e7464c8e6e62ffe |
| institution | OA Journals |
| issn | 2090-6625 2090-6633 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Infectious Diseases |
| spelling | doaj-art-5680ca8ec17a4a7b9e7464c8e6e62ffe2025-08-20T02:06:00ZengWileyCase Reports in Infectious Diseases2090-66252090-66332017-01-01201710.1155/2017/54092545409254Immune Reconstitution Inflammatory Syndrome: Opening Pandora’s BoxMariana Meireles0Conceição Souto Moura1Margarida França2Internal Medicine Department, Porto Hospital Centre, Porto, PortugalPathological Anatomy Department, São João Hospital Centre, Porto, PortugalClinical Immunology Unit, Porto Hospital Centre, Porto, PortugalOne of the purposes of antiretroviral therapy (ART) is to restore the immune system. However, it can sometimes lead to an aberrant inflammatory response and paradoxical clinical worsening known as the immune reconstitution inflammatory syndrome (IRIS). We describe a 23-year-old male, HIV1 infected with a rapid progression phenotype, who started ART with TCD4+ of 53 cells/mm3 (3,3%) and HIV RNA = 890000 copies/mL (6 log). Four weeks later he was admitted to the intensive care unit with severe sepsis. The diagnostic pathway identified progressive multifocal leukoencephalopathy, digestive Kaposi sarcoma, and P. aeruginosa bacteraemia. Five weeks after starting ART, TCD4+ cell count was 259 cells/mm3 (15%) and HIV RNA = 3500 copies/mL (4 log). He developed respiratory failure and progressed to septic shock and death. Those complications might justify the outcome but its autopsy opened Pandora’s box: cerebral and cardiac toxoplasmosis was identified, as well as hemophagocytic syndrome, systemic candidiasis, and Mycobacterium avium complex infection. IRIS remains a concern and eventually a barrier to ART. Male gender, young age, low TCD4 cell count, and high viral load are risk factors. The high prevalence of subclinical opportunistic diseases highlights the need for new strategies to reduce IRIS incidence.http://dx.doi.org/10.1155/2017/5409254 |
| spellingShingle | Mariana Meireles Conceição Souto Moura Margarida França Immune Reconstitution Inflammatory Syndrome: Opening Pandora’s Box Case Reports in Infectious Diseases |
| title | Immune Reconstitution Inflammatory Syndrome: Opening Pandora’s Box |
| title_full | Immune Reconstitution Inflammatory Syndrome: Opening Pandora’s Box |
| title_fullStr | Immune Reconstitution Inflammatory Syndrome: Opening Pandora’s Box |
| title_full_unstemmed | Immune Reconstitution Inflammatory Syndrome: Opening Pandora’s Box |
| title_short | Immune Reconstitution Inflammatory Syndrome: Opening Pandora’s Box |
| title_sort | immune reconstitution inflammatory syndrome opening pandora s box |
| url | http://dx.doi.org/10.1155/2017/5409254 |
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