Histoplasmosis-associated immune reconstitution inflammatory syndrome

A 27-year-old HIV-positive male patient with disseminated cutaneous histoplasmosis was treated with both HAART and amphotericin B (total accumulated dose of 0.5 g). Amphotericin B was later replaced with itraconazole (200mg/day). Two months after therapy had been started and the cutaneous lesions ha...

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Bibliographic Details
Published in:Anais brasileiros de dermatología 2011-07, Vol.86 (4 Suppl 1), p.S168-S172
Main Authors: Passos, Leny, Talhari, Carolina, Santos, Monica, Ribeiro-Rodrigues, Rodrigo, Ferreira, Luiz Carlos de Lima, Talhari, Sinesio
Format: Article
Language:eng ; por
Subjects:
Adult
AIDS-Related Opportunistic Infections - complications
AIDS-Related Opportunistic Infections - immunology
Antiretroviral Therapy, Highly Active
CD4 Lymphocyte Count
Histoplasmosis - complications
Histoplasmosis - immunology
Humans
Immune Reconstitution Inflammatory Syndrome - complications
Immune Reconstitution Inflammatory Syndrome - immunology
Male
Medication Adherence
Viral Load
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Summary:A 27-year-old HIV-positive male patient with disseminated cutaneous histoplasmosis was treated with both HAART and amphotericin B (total accumulated dose of 0.5 g). Amphotericin B was later replaced with itraconazole (200mg/day). Two months after therapy had been started and the cutaneous lesions had healed, the patient interrupted both treatments voluntarily and his health deteriorated. HAART was then re-introduced and CD4+ cell count increased sharply at the same time as lymph node histoplasmosis was diagnosed. This paradoxical response? the relapse of histoplasmosis and concomitant increase in CD4+ cell count and undetectable viral load after resumption of HAART ? suggests that this was a case of immune reconstitution inflammatory syndrome (IRIS).
ISSN:1806-4841
DOI:10.1590/S0365-05962011000700044