Immune reconstitution inflammatory syndrome in HIV and sporotrichosis coinfection: report of two cases and review of the literature

Abstract

We report 2 cases of patients with immune reconstitution infl ammatory syndrome (IRIS) associated with cutaneous disseminated sporotrichosis and human immunodefi ciency virus (HIV) coinfection. The patients received specifi c treatment for sporotrichosis. However, after 4 and 5 weeks from the beginning of antiretroviral therapy, both patients experienced clinical exacerbation of skin lesions despite increased T CD4+ cells (T cells cluster of differentiation 4 positive) count and decreased viral load. Despite this exacerbation, subsequent mycological examination after systemic corticosteroid administration did not reveal fungal growth. Accordingly, they were diagnosed with IRIS. However, the sudden withdrawal of the corticosteroids resulted in the recurrence of IRIS symptoms. No serious adverse effects could be attributed to prednisone. We recommend corticosteroid treatment for mildto-moderate cases of IRIS in sporotrichosis and HIV coinfection with close follow-up.

Immunopathogenesis of Human Sporotrichosis: What We Already Know

“…The main forms of clinical presentation are lymphocutanous sporotrichosis (LC) and fixed sporotrichosis (F) ( Figure 1 ). Although less common, mucosal, cutaneous disseminated, and extracutaneous forms (including osteoarticular, pulmonary, meningitis, exogenous, and endogenous endophthalmitis) have also been described ( Table 1 ) [ 11 , 12 , 22 , 24 , 30 , 47 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 ].…”

“…Disseminated sporotrichosis has been described in one liver transplanted patient [ 124 ]. In co-infection HIV/ S. schenckii , the clinical exacerbation of skin lesions or unusual clinical forms such as cutaneous dissemination, extracutaneous forms, or the development of meningitis in some cases has been observed as a result of immune reconstitution inflammatory syndrome [ 22 , 71 , 73 , 74 , 75 ]. Some patients have shown skin lesions before central nervous system involvement, which suggests the hematogenous dissemination of fungus [ 74 ].…”

Comment on: Carotid-cavernous fistula: current concepts in aetiology, investigation and management

“…A total of 43 publications reporting 65 individual case reports were included for data extraction and analysis (supplementary information) [1,3,[5][6][7]. The EE rate in patients co-infected by HIV and sporotrichosis was 7.7% (7 eyes of 5 patients).…”

Cutaneous Disseminated and Extracutaneous Sporotrichosis: Current Status of a Complex Disease

“…Central nervous system involvement manifests as meningoencephalitis and hydrocephalus, clinical symptoms include headache, fever, neck stiffness, mental confusion and vomiting; the main differential diagnosis is cryptococcosis [ 4 , 67 ]. It is also important to mention that because of the antiretroviral therapy, immune reconstitution inflammatory syndrome can be present; it is estimated that it occurs in little more than 7% and there can be diverse clinical manifestations [ 34 , 36 , 68 , 69 ].…”