A case of vitiligo occurring after initiation of antiretroviral treatment and disappearing during this treatment: autoimmune IRIS syndrome?

• Published in: Annales de dermatologie et de vénéréologie 2012-11, Vol.139 (11), p.736-738
• Main Authors: Defo, D, Kouotou, E A, Bissek, A C, Mboua, J B
• Format: Article
• Language: fre
• Subjects: Adult; Anti-HIV Agents - adverse effects; Anti-HIV Agents - therapeutic use; Benzoxazines - adverse effects; Benzoxazines - therapeutic use; Drug Therapy, Combination; Follow-Up Studies; HIV Seropositivity - drug therapy; Humans; Immune Reconstitution Inflammatory Syndrome - chemically induced; Immune Reconstitution Inflammatory Syndrome - diagnosis; Immune Reconstitution Inflammatory Syndrome - drug therapy; Lamivudine - adverse effects; Lamivudine - therapeutic use; Male; Viral Load; Vitiligo - chemically induced; Vitiligo - diagnosis; Vitiligo - drug therapy; Zidovudine - adverse effects; Zidovudine - therapeutic use
• ISSN: 0151-9638
• DOI: 10.1016/j.annder.2012.06.049

Immune reconstitution inflammatory syndrome (IRIS) includes all signs occurring during the reconstitution of an extensive and insufficiently regulated immune response to an infective or a non-infective antigen and observed during the immune suppression phase in an individual. We report a case of vitiligo appearing after the initiation of antiretroviral treatment and with repigmentation during the course of the treatment. A 30-year-old man, seropositive for HIV1-M, consulted for a diffuse eruption of hypopigmented and achromic macules. The lesions appeared 7 weeks after the start of antiretroviral therapy with zidovudine, lamivudine and efavirenz, starting on the forearm and spreading to the remainder of the skin. At control visits during the ensuing two months, gradual repigmentation of the achromic macules was noted. Plasma viral load, determined only during the treatment period, was less than 40 copies/ml (1.60(log)). This report concerns an original case of vitiligo occurring at the start of antiretroviral treatment in an HIV-positive patient, with spontaneous repigmentation during treatment. The chronology points to a hypothesis of immune reconstitution inflammatory syndrome (IRIS), despite the absence of any indication of the patient's viral load prior to therapy.