ARTICLE IN PRESS
BJID 310 1–2
b r a z j i n f e c t d i s . 2 0 1 4;x x x(x x):xxx–xxx
The Brazilian Journal of
INFECTIOUS DISEASES www.elsevier.com/locate/bjid
Clinical image
1
AIDS and disseminated tuberculosis after Immune Reconstitution Inflammatory Syndrome
2
3
4
Q1
Gonul Sengoz a , Ahmet Sengoz b , Filiz Pehlivanoglu a,∗
5
a
6
b
Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey Neurosurgery Clinic, Yenibosna Safa Hospital, Istanbul, Turkey
7
8
a r t i c l e
i n f o
9 10
Article history:
11
Received 14 January 2014
12
Accepted 21 January 2014
13
Available online xxx
14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35
A 29-year-old male patient was admitted at the hospital with complaints of diarrhea and weight loss that had started two months ago. In his physical examination and laboratory tests, HIV positivity was detected (CD4 cell count 175 mL–1 , HIV RNA 9,800,000 copies/mL). At the end of the first month of antiretroviral therapy he was admitted to the hospital again with deterioration in his general medical condition, respiratory distress and loss of consciousness. Massive pleural effusion in the right hemithorax, and diffuse bilateral micronodular infiltration in both lungs were detected by thoracic computerized tomographic (CT) examination (Fig. 1). A lesion (tuberculoma) was observed in the cranial magnetic resonance imaging (MRI) (Fig. 2). There were hypodense nodular lesions in the liver and spleen, and mesenchymal multiple lymphadenopathy (LAP) in the abdominal CT (Fig. 3). Mycobacterium tuberculosis grew on the 35th day after pleural fluid culture in Löwenstein Jensen culture media. Treatment with antituberculosis agents and 60 mg prednisolone was started. Bilateral distal motor and sensory neuropathy developed during follow-up. Multiple nodular lesions (tuberculomas) were detected in the spine in spinal MRI (Fig. 4). The patient was discharged on the second month of treatment with partial recovery.
Fig. 1 – Massive pleural effusion in the right hemithorax, diffuse bilateral micronodular infiltration in both lungs, and hilar lymphadenopathy in thoracic CT.
∗ ˘ Haseki Egitim ˘ Corresponding author at: Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Klinigi, ve Aras¸tırma Hastanesi, Adnan Adıvar Cad. Fatih, I˙stanbul, Turkey. E-mail addresses: drfi[email protected], drfi[email protected] (F. Pehlivanoglu). 1413-8670/$ – see front matter © 2014 Published by Elsevier Editora Ltda. http://dx.doi.org/10.1016/j.bjid.2014.01.004
Please cite this article in press as: Sengoz G, et al. AIDS and disseminated tuberculosis after Immune Reconstitution Inflammatory Syndrome. BJID 310 1–2 Braz J Infect Dis. 2014. http://dx.doi.org/10.1016/j.bjid.2014.01.004
BJID 310 1–2
2
ARTICLE IN PRESS b r a z j i n f e c t d i s . 2 0 1 4;x x x(x x):xxx–xxx
Fig. 4 – Multiple nodular lesions (tuberculomas) in the vertebral corpus in spinal MRI. Fig. 2 – Lesion on the right cerebellar hemisphere of approximately 1 cm, which was hypointense in T1 and hyperintense in T2 weighted images in cranial MRI.
of an existing infection or appearance of a new infection soon after initiation of ART.
Conflicts of interest
40 41
Q2
The authors declare no conflicts of interest.
Uncited references Refs. 1–3.
42
Q3
43 44
references 45
Fig. 3 – Hypodense nodular lesions in the liver and spleen, and mesenchymal multiple lymphadenopathy in the abdominal CT.
36 37 38 39
Initiation of antiretroviral therapy (ART) in HIV-infected patients leads to restoration of the immune functions. On the other hand, dysregulated immune response after initiation of ART leads to the phenomenon of Immune Reconstitution Inflammatory Syndrome (IRIS). IRIS is paradoxical worsening
1. Bonnet M, Baudin E, Jani IV, et al. Incidence of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome and impact on patient outcome. PLoS ONE. 2013;8:e84585, http://dx.doi.org/10.1371/journal.pone.0084585. 2. Breton G, Bourgarit A, Pavy S, et al. Treatment for tuberculosis-associated immune reconstitution inflammatory syndrome in 34 HIV-infected patients. Int J Tuberc Lung Dis. 2012;16:1365–70. 3. Viskovic K, Begovac J. Tuberculosis-Associated Immune Reconstruction Inflammatory Syndrome (TB-IRIS) in HIV-infected patients: report of two cases and the literature overview. Case Rep Infect Dis. 2013;2013. 7 pp. [Article ID 323208].
Please cite this article in press as: Sengoz G, et al. AIDS and disseminated tuberculosis after Immune Reconstitution Inflammatory Syndrome. BJID 310 1–2 Braz J Infect Dis. 2014. http://dx.doi.org/10.1016/j.bjid.2014.01.004
46 47 48 49 50 51 52 53 54 55 56 57 58
BJID 310 1–2
b r a z j i n f e c t d i s . 2 0 1 4;x x x(x x):xxx–xxx
The Brazilian Journal of
INFECTIOUS DISEASES www.elsevier.com/locate/bjid
Clinical image
1
AIDS and disseminated tuberculosis after Immune Reconstitution Inflammatory Syndrome
2
3
4
Q1
Gonul Sengoz a , Ahmet Sengoz b , Filiz Pehlivanoglu a,∗
5
a
6
b
Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey Neurosurgery Clinic, Yenibosna Safa Hospital, Istanbul, Turkey
7
8
a r t i c l e
i n f o
9 10
Article history:
11
Received 14 January 2014
12
Accepted 21 January 2014
13
Available online xxx
14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35
A 29-year-old male patient was admitted at the hospital with complaints of diarrhea and weight loss that had started two months ago. In his physical examination and laboratory tests, HIV positivity was detected (CD4 cell count 175 mL–1 , HIV RNA 9,800,000 copies/mL). At the end of the first month of antiretroviral therapy he was admitted to the hospital again with deterioration in his general medical condition, respiratory distress and loss of consciousness. Massive pleural effusion in the right hemithorax, and diffuse bilateral micronodular infiltration in both lungs were detected by thoracic computerized tomographic (CT) examination (Fig. 1). A lesion (tuberculoma) was observed in the cranial magnetic resonance imaging (MRI) (Fig. 2). There were hypodense nodular lesions in the liver and spleen, and mesenchymal multiple lymphadenopathy (LAP) in the abdominal CT (Fig. 3). Mycobacterium tuberculosis grew on the 35th day after pleural fluid culture in Löwenstein Jensen culture media. Treatment with antituberculosis agents and 60 mg prednisolone was started. Bilateral distal motor and sensory neuropathy developed during follow-up. Multiple nodular lesions (tuberculomas) were detected in the spine in spinal MRI (Fig. 4). The patient was discharged on the second month of treatment with partial recovery.
Fig. 1 – Massive pleural effusion in the right hemithorax, diffuse bilateral micronodular infiltration in both lungs, and hilar lymphadenopathy in thoracic CT.
∗ ˘ Haseki Egitim ˘ Corresponding author at: Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Klinigi, ve Aras¸tırma Hastanesi, Adnan Adıvar Cad. Fatih, I˙stanbul, Turkey. E-mail addresses: drfi[email protected], drfi[email protected] (F. Pehlivanoglu). 1413-8670/$ – see front matter © 2014 Published by Elsevier Editora Ltda. http://dx.doi.org/10.1016/j.bjid.2014.01.004
Please cite this article in press as: Sengoz G, et al. AIDS and disseminated tuberculosis after Immune Reconstitution Inflammatory Syndrome. BJID 310 1–2 Braz J Infect Dis. 2014. http://dx.doi.org/10.1016/j.bjid.2014.01.004
BJID 310 1–2
2
ARTICLE IN PRESS b r a z j i n f e c t d i s . 2 0 1 4;x x x(x x):xxx–xxx
Fig. 4 – Multiple nodular lesions (tuberculomas) in the vertebral corpus in spinal MRI. Fig. 2 – Lesion on the right cerebellar hemisphere of approximately 1 cm, which was hypointense in T1 and hyperintense in T2 weighted images in cranial MRI.
of an existing infection or appearance of a new infection soon after initiation of ART.
Conflicts of interest
40 41
Q2
The authors declare no conflicts of interest.
Uncited references Refs. 1–3.
42
Q3
43 44
references 45
Fig. 3 – Hypodense nodular lesions in the liver and spleen, and mesenchymal multiple lymphadenopathy in the abdominal CT.
36 37 38 39
Initiation of antiretroviral therapy (ART) in HIV-infected patients leads to restoration of the immune functions. On the other hand, dysregulated immune response after initiation of ART leads to the phenomenon of Immune Reconstitution Inflammatory Syndrome (IRIS). IRIS is paradoxical worsening
1. Bonnet M, Baudin E, Jani IV, et al. Incidence of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome and impact on patient outcome. PLoS ONE. 2013;8:e84585, http://dx.doi.org/10.1371/journal.pone.0084585. 2. Breton G, Bourgarit A, Pavy S, et al. Treatment for tuberculosis-associated immune reconstitution inflammatory syndrome in 34 HIV-infected patients. Int J Tuberc Lung Dis. 2012;16:1365–70. 3. Viskovic K, Begovac J. Tuberculosis-Associated Immune Reconstruction Inflammatory Syndrome (TB-IRIS) in HIV-infected patients: report of two cases and the literature overview. Case Rep Infect Dis. 2013;2013. 7 pp. [Article ID 323208].
Please cite this article in press as: Sengoz G, et al. AIDS and disseminated tuberculosis after Immune Reconstitution Inflammatory Syndrome. BJID 310 1–2 Braz J Infect Dis. 2014. http://dx.doi.org/10.1016/j.bjid.2014.01.004
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