PMID- 26187282 OWN - NLM STAT- MEDLINE DCOM- 20160104 LR - 20181113 IS - 1471-2342 (Electronic) IS - 1471-2342 (Linking) VI - 15 DP - 2015 Jul 18 TI - Immune reconstitution inflammatory syndrome due to Mycobacterium avium complex successfully followed up using 18 F-fluorodeoxyglucose positron emission tomography-computed tomography in a patient with human immunodeficiency virus infection: A case report. PG - 24 LID - 10.1186/s12880-015-0063-2 [doi] LID - 24 AB - BACKGROUND: In human immunodeficiency virus (HIV)-infected patients, immune reconstitution inflammatory syndrome (IRIS) due to nontuberculous mycobacteria (NTM) infection is one of the most difficult types of IRIS to manage. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has been suggested as a useful tool for evaluating the inflammatory status of HIV-infected patients. We present the first case of Mycobacterium avium complex (MAC)-associated IRIS (MAC-IRIS) that was successfully followed up using 18F-FDG PET/CT. CASE PRESENTATION: A 44-year-old homosexual Japanese man was referred to our hospital with fever and dyspnea. He was diagnosed with Pneumocystis jiroveci pneumonia and found to be HIV positive. After the initiation of combined antiretroviral therapy (cART), the patient's mediastinal and bilateral hilar lymphadenopathy gradually enlarged, and bilateral infiltrates appeared in the upper lung fields. 18F-FDG PET/CT was performed five months after the initiation of cART and showed intense accumulation of fluorodeoxyglucose (FDG) corresponding to the lesions of infiltration as well as the mediastinal and bilateral hilar lymphadenopathy. A bronchial wash culture and pathology findings led to a diagnosis of MAC-IRIS. Anti-mycobacterial chemotherapy with rifampicin, ethambutol, clarithromycin, and levofloxacin was started. One year after the chemotherapy was initiated, there was a significant reduction in FDG uptake in the area of the lesions except in the mediastinal lymph node. This implied incomplete resolution of the MAC-IRIS-related inflammation. Anti-mycobacterial chemotherapy was continued because of the residual lesion. To date, the patient has not experienced a recurrence of MAC-IRIS, a period of nine months. CONCLUSION: We present a case of MAC-IRIS in an HIV-infected patient whose disease activity was successfully followed up using 18F-FDG PET/CT. Our data suggest that 18F-FDG PET/CT is useful for evaluating the disease activity of NTM-IRIS and assessing the appropriate duration of anti-mycobacterial chemotherapy for NTM-IRIS in HIV-infected patients. FAU - Namkoong, Ho AU - Namkoong H AD - Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. hounamugun@gmail.com. AD - Japan Society for the Promotion of Science, Tokyo, Japan. hounamugun@gmail.com. FAU - Fujiwara, Hiroshi AU - Fujiwara H AD - Center for Infectious Diseases and Infection Control, Keio University School of Medicine, Tokyo, Japan. lecafe1979@yahoo.co.jp. FAU - Ishii, Makoto AU - Ishii M AD - Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. ishii@z6.keio.jp. FAU - Yagi, Kazuma AU - Yagi K AD - Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. kazumayagi1214@yahoo.co.jp. FAU - Haraguchi, Mizuha AU - Haraguchi M AD - Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. mizuha-h@rf7.so-net.ne.jp. FAU - Matsusaka, Masako AU - Matsusaka M AD - Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. apfel0110@gmail.com. FAU - Suzuki, Shoji AU - Suzuki S AD - Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. shojis221@gmail.com. FAU - Asakura, Takanori AU - Asakura T AD - Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. takanori.asakura@gmail.com. FAU - Asami, Takahiro AU - Asami T AD - Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. asamitakahiro@gmail.com. FAU - Saito, Fumitake AU - Saito F AD - Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. fumitake.cpnet@gmail.com. FAU - Fukunaga, Koichi AU - Fukunaga K AD - Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. k-fuku@jf7.so-net.ne.jp. FAU - Tasaka, Sadatomo AU - Tasaka S AD - Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. tasaka@cpnet.med.keio.ac.jp. FAU - Betsuyaku, Tomoko AU - Betsuyaku T AD - Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. tbetsuyaku@z5.keio.jp. FAU - Hasegawa, Naoki AU - Hasegawa N AD - Center for Infectious Diseases and Infection Control, Keio University School of Medicine, Tokyo, Japan. n-hasegawa@z8.keio.jp. LA - eng PT - Case Reports PT - Journal Article DEP - 20150718 PL - England TA - BMC Med Imaging JT - BMC medical imaging JID - 100968553 RN - 0 (Radiopharmaceuticals) RN - 0Z5B2CJX4D (Fluorodeoxyglucose F18) SB - IM MH - Adult MH - Fluorodeoxyglucose F18 MH - HIV Infections/*complications/diagnosis/microbiology MH - Humans MH - Immune Reconstitution Inflammatory Syndrome/*diagnosis/*etiology/microbiology MH - Male MH - Multimodal Imaging/methods MH - Mycobacterium avium-intracellulare Infection/*complications/*diagnosis/microbiology MH - Positron-Emission Tomography/*methods MH - Radiopharmaceuticals MH - Tomography, X-Ray Computed/methods PMC - PMC4506418 EDAT- 2015/07/19 06:00 MHDA- 2016/01/05 06:00 PMCR- 2015/07/18 CRDT- 2015/07/19 06:00 PHST- 2015/01/28 00:00 [received] PHST- 2015/06/02 00:00 [accepted] PHST- 2015/07/19 06:00 [entrez] PHST- 2015/07/19 06:00 [pubmed] PHST- 2016/01/05 06:00 [medline] PHST- 2015/07/18 00:00 [pmc-release] AID - 10.1186/s12880-015-0063-2 [pii] AID - 63 [pii] AID - 10.1186/s12880-015-0063-2 [doi] PST - epublish SO - BMC Med Imaging. 2015 Jul 18;15:24. doi: 10.1186/s12880-015-0063-2.