PMID- 27566775
OWN - NLM
STAT- MEDLINE
DCOM- 20180102
LR  - 20180205
IS  - 1758-1052 (Electronic)
IS  - 0956-4624 (Linking)
VI  - 28
IP  - 3
DP  - 2017 Mar
TI  - Immune reconstitution inflammatory syndrome associated with secondary syphilis.
PG  - 302-305
LID - 10.1177/0956462416664469 [doi]
AB  - Immune reconstitution inflammatory syndrome (IRIS) is a condition associated with 
      paradoxical worsening and/or new onset of an opportunistic infection in HIV 
      patients following the initiation of anti-retroviral therapy or switching to more 
      potent antiretroviral therapy (ART) regimen. Although IRIS associated with many 
      opportunistic infections (OIs) has been well reported, syphilis has very rarely 
      been mentioned in this regard. A 52-year-old male, diagnosed with AIDS six weeks 
      ago, presented with the disseminated non-pruritic painless skin rash. He denied 
      any fever, cough, shortness of breath, and joint pain or swelling. The patient 
      had no similar symptoms, genital ulcers, or any medical illness in the past. CD4 
      cell count and viral load were 40 cells/mm(3) and 280,000 copies/ml, 
      respectively, while screening tests for OIs including rapid plasma reagin test, 
      quantiferon, cryptococcal antigen, and toxoplasma tests were negative at the time 
      of HIV diagnosis. After three days of initiation of anti-retroviral therapy, he 
      developed the above-mentioned skin rash. Repeat rapid plasma regain (RPR) test at 
      this time was also negative. Punch biopsy of the skin lesion demonstrated 
      findings suggestive of secondary syphilitic lesions, which was confirmed by 
      immunostain. The repeat RPR, CD4 cell count, and viral load showed a titer of 
      1:256, 257 cells/mm(3), and 5000 copies/ml, respectively. His skin rashes faded 
      away, and RPR titer trended down on treatment with benzathine penicillin without 
      discontinuation of ART. The presence of an IRIS response does not predict overall 
      HIV or OI treatment responses, and discontinuation of ART is not generally 
      recommended as the benefits of treating HIV infection outweighs the risk 
      associated with IRIS.
FAU - Frunza-Stefan, Simona
AU  - Frunza-Stefan S
AD  - 1 Department of Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, NY, 
      USA.
FAU - Acharya, Gyanendra
AU  - Acharya G
AD  - 1 Department of Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, NY, 
      USA.
FAU - Kazlouskaya, Viktoryia
AU  - Kazlouskaya V
AD  - 1 Department of Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, NY, 
      USA.
FAU - Vukasinov, Paunel
AU  - Vukasinov P
AD  - 1 Department of Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, NY, 
      USA.
FAU - Chiou, Yushan
AU  - Chiou Y
AD  - 3 Ackerman Academy of Dermatopathology, NY, USA.
FAU - Thet, Zeyar
AU  - Thet Z
AD  - 2 Division of Infectious Disease, Department of Internal Medicine, Wyckoff 
      Heights Medical Center, Brooklyn, NY USA.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20160927
PL  - England
TA  - Int J STD AIDS
JT  - International journal of STD & AIDS
JID - 9007917
RN  - RIT82F58GK (Penicillin G Benzathine)
RN  - Syphilis, secondary
SB  - IM
MH  - *Antiretroviral Therapy, Highly Active
MH  - CD4 Lymphocyte Count
MH  - HIV Infections/complications/*drug therapy
MH  - Humans
MH  - Immune Reconstitution Inflammatory 
      Syndrome/diagnosis/*etiology/immunology/pathology
MH  - Male
MH  - Middle Aged
MH  - Penicillin G Benzathine/*therapeutic use
MH  - Syphilis/*complications/diagnosis/drug therapy
MH  - Syphilis Serodiagnosis
MH  - Treatment Outcome
MH  - Viral Load
OTO - NOTNLM
OT  - HIV
OT  - Highly active antiretroviral therapy
OT  - IRIS
OT  - North America
OT  - syphilis
EDAT- 2016/08/28 06:00
MHDA- 2018/01/03 06:00
CRDT- 2016/08/28 06:00
PHST- 2016/08/28 06:00 [pubmed]
PHST- 2018/01/03 06:00 [medline]
PHST- 2016/08/28 06:00 [entrez]
AID - 0956462416664469 [pii]
AID - 10.1177/0956462416664469 [doi]
PST - ppublish
SO  - Int J STD AIDS. 2017 Mar;28(3):302-305. doi: 10.1177/0956462416664469. Epub 2016 
      Sep 27.