HIV and tuberculosis (TB) are leading global causes of mortality and morbidity. Highly active antiretroviral therapy (HAART) is often initiated in patients being treated for TB. The immune recovery associated with HAART results in dramatic clinical benefits, but this restoration of immunity may result in immunopathological reactions. The immune reconstitution inflammatory syndrome can result in fever, nodal enlargement, and worsening pulmonary infiltrates observed on a chest radiograph, with or without recurrent respiratory symptoms. Several other manifestations have also been described. As a consequence, the use of HAART might not be appropriate during the first weeks of anti-TB therapy in HIV-infected patients. In this review, we summarize the incidence, clinical presentations, and potential mechanisms of these conditions and we describe therapeutic methods.
Toxic megacolon is a severe complication of Clostridium difficile infection (CDI) with a high percentage of mortality. The mainstay of treatment is currently represented by medical management, while surgical intervention is indicated in patients not improving after 2-3 days of antibiotic therapy. Generally metronidazole and vancomycin are administered as first-line treatment, but recently several cases of refractory C. difficile have made the treatment of this infection more difficult. Fidaxomicin is a narrow-spectrum oral macrocyclic antibiotic with excellent in vitro activity against C. difficile strains. We report the case of a woman admitted with a diagnosis of toxic megacolon complicating a C. difficile colitis not responding to standard antibiotic therapy.
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