Soft tissue abscess and lymphadenitis due to Mycobacterium avium Complex as an expression of immune reconstitution inflammatory syndrome after a second scheme of highly active antiretroviral therapy

Corti, Marcelo; Villafañe, María F.; Ambroggi, Marta; Sawicki, Mirna; Gancedo, Elisa

doi:10.1590/s0036-46652007000400015

Cited by 10 publications

(5 citation statements)

References 19 publications

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“…[20][21][22] This phenomenon, called "paradoxical reaction" 22 or "immune reconstitution inflammatory syndrome (IRIS)," has also been described in patients with HIV who are coinfected with other mycobacteria, such as Mycobacterium tuberculosis or Mycobacterium leprae . 23,24 Although our patient was HIV-negative, the IRIS is highly supported by the clinical characteristics (fever, swelling, or abscess) previously described, 20,[24][25][26] the increase in the WBC count, the alpha-1, alpha-2, and gamma globulin values ( Table 2 ), and the histopathologic results. Because of technical constraints, the immune status of this patient was not extensively assessed at admission.…”

Section: Discussionsupporting

confidence: 78%

Severe Multifocal Form of Buruli Ulcer after Streptomycin and Rifampin Treatment: Comments on Possible Dissemination Mechanisms

Sopoh¹,

Dossou²,

Brun³

et al. 2010

The American Society of Tropical Medicine and Hygiene

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Buruli ulcer (BU), a disease caused by Mycobacterium ulcerans, leads to the destruction of skin and sometimes bone. Here, we report a case of severe multifocal BU with osteomyelitis in a 6-year-old human immunodeficiency virus (HIV)-negative boy. Such disseminated forms are poorly documented and generally occur in patients with HIV co-infection. The advent of antibiotic treatment with streptomycin (S) and rifampin (R) raised hope that these multifocal BU cases could be reduced. The present case raises two relevant points about multifocal BU: the mechanism of dissemination that leads to the development of multiple foci and the difficulties of treatment of multifocal forms of BU. Biochemical (hypoproteinemia), hematological (anemia), clinical (traditional treatment), and genetic factors are discussed as possible risk factors for dissemination.

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Section: Discussionsupporting

confidence: 78%

Severe Multifocal Form of Buruli Ulcer after Streptomycin and Rifampin Treatment: Comments on Possible Dissemination Mechanisms

Sopoh¹,

Dossou²,

Brun³

et al. 2010

The American Society of Tropical Medicine and Hygiene

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“…The term immune reconstitution inflammatory syndrome (IRIS) has been defined as “a paradoxical deterioration in clinical status attributable to the recovery of the immune system during HAART.” 1 The disorder, in the context of human immunodeficiency virus (HIV) infection, was first described in 1992 when a patient developed an acute Mycobacterium avium ‐ intracellulare infection after the initiation of antiretroviral therapy 2 . Subsequently, IRIS was recognized in patients with a wide variety of presentations and associated pathogens 3–13 . IRIS is also referred to as immune restoration disease (IRD) or immune reconstitution syndrome (IRS), however all names refer to a disease process due to the reemergence of a functional immune system as opposed to a disorder due to immune suppression.…”

Section: Introductionmentioning

confidence: 99%

Neurological complications of immune reconstitution in HIV‐infected populations

Johnson

2010

Annals of the New York Academy of Sciences

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The introduction of highly active antiretroviral therapy (HAART) for human immunodeficiency virus (HIV) infection has transformed this disease from a fatal infection to a chronic yet manageable condition by restoring immune function. All the same, this restoration of immune response in some may be associated with deterioration in clinical status, which has been termed immune reconstitution inflammatory syndrome (IRIS). This syndrome often occurs in the context of an underlying opportunistic infection and develops after an interval of weeks to months after the initiation of HAART. Occasionally, IRIS may occur in the brain without any opportunistic infection, which presents as a T cell-mediated encephalitis. This paradoxical infiltration of previously immune suppressed patients with T cells represents a diagnostic challenge and a treatment dilemma. Nonetheless, CNS-IRIS with or without an opportunistic infection can range in severity. Severe cases can be fatal and hence require intervention with steroid treatment. This review discusses the diagnosis, clinical manifestations, risk factors, pathophysiology, and potential treatment strategies of the various forms of IRIS that involve the nervous system.

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“…Although infection should always be excluded in the context of immunosuppression, other than tenderness to palpation there were no findings prior to biopsy in our case that were particularly indicative of infection. Soft tissue abscess due to mycobacterial infection has been noted in patients with AIDS [ 5 ]. In our patient there was no antecedent trauma which may have caused localized nodular fat necrosis or fasciitis.…”

Section: Discussionmentioning

confidence: 99%