PMID- 28086758 OWN - NLM STAT- MEDLINE DCOM- 20170707 LR - 20181202 IS - 1471-2334 (Electronic) IS - 1471-2334 (Linking) VI - 17 IP - 1 DP - 2017 Jan 13 TI - Toxoplasmosis-associated IRIS involving the CNS: a case report with longitudinal analysis of T cell subsets. PG - 66 LID - 10.1186/s12879-016-2159-x [doi] LID - 66 AB - BACKGROUND: HIV-infected patients may present an unforeseen clinical worsening after initiating antiretroviral therapy known as immune reconstitution inflammatory syndrome (IRIS). This syndrome is characterized by a heightened inflammatory response toward infectious or non-infectious triggers, and it may affect different organs. Diagnosis of IRIS involving the central nervous system (CNS-IRIS) is challenging due to heterogeneous manifestations, absence of biomarkers to identify this condition, risk of long-term sequelae and high mortality. Hence, a deeper knowledge of CNS-IRIS pathogenesis is needed. CASE PRESENTATION: A 37-year-old man was diagnosed with AIDS and cerebral toxoplasmosis. Anti-toxoplasma treatment was initiated immediately, followed by active antiretroviral therapy (HAART) 1 month later. At 2 months of HAART, he presented with progressive hyposensitivity of the right lower limb associated with brain and dorsal spinal cord lesions, compatible with paradoxical toxoplasmosis-associated CNS-IRIS, a condition with very few reported cases. A stereotactic biopsy was planned but was postponed based on its inherent risks. Patient showed clinical improvement with no requirement of corticosteroid therapy. Routine laboratorial analysis was complemented with longitudinal evaluation of blood T cell subsets at 0, 1, 2, 3 and 6 months upon HAART initiation. A control group composed by 9 HIV-infected patients from the same hospital but with no IRIS was analysed for comparison. The CNS-IRIS patient showed lower percentage of memory CD4(+) T cells and higher percentage of activated CD4(+) T cells at HAART initiation. The percentage of memory CD4(+) T cells drastically increased at 1 month after HAART initiation and became higher in comparison to the control group until clinical recovery onset; the percentage of memory CD8(+) T cells was consistently lower throughout follow-up. Interestingly, the percentage of regulatory T cells (Treg) on the CNS-IRIS patient reached a minimum around 1 month before symptoms onset. CONCLUSION: Although both stereotactic biopsies and steroid therapy might be of use in CNS-IRIS cases and should be considered for these patients, they might be unnecessary to achieve clinical improvement as shown in this case. Immunological characterization of more CNS-IRIS cases is essential to shed some light on the pathogenesis of this condition. FAU - Rb-Silva, Rita AU - Rb-Silva R AD - Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal. AD - ICVS/3B's, PT Government Associate Laboratory, Braga/Guimaraes, Portugal. FAU - Nobrega, Claudia AU - Nobrega C AD - Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal. AD - ICVS/3B's, PT Government Associate Laboratory, Braga/Guimaraes, Portugal. FAU - Reiriz, Eugenia AU - Reiriz E AD - Department of Infectious Diseases of Centro Hospitalar do Porto, Hospital Joaquim Urbano Unit, Porto, Portugal. FAU - Almeida, Soraia AU - Almeida S AD - Department of Infectious Diseases of Centro Hospitalar do Porto, Hospital Joaquim Urbano Unit, Porto, Portugal. FAU - Sarmento-Castro, Rui AU - Sarmento-Castro R AD - Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal. AD - ICVS/3B's, PT Government Associate Laboratory, Braga/Guimaraes, Portugal. AD - Department of Infectious Diseases of Centro Hospitalar do Porto, Hospital Joaquim Urbano Unit, Porto, Portugal. FAU - Correia-Neves, Margarida AU - Correia-Neves M AD - Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal. mcorreianeves@med.uminho.pt. AD - ICVS/3B's, PT Government Associate Laboratory, Braga/Guimaraes, Portugal. mcorreianeves@med.uminho.pt. FAU - Horta, Ana AU - Horta A AD - Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal. AD - ICVS/3B's, PT Government Associate Laboratory, Braga/Guimaraes, Portugal. AD - Department of Infectious Diseases of Centro Hospitalar do Porto, Hospital Joaquim Urbano Unit, Porto, Portugal. LA - eng PT - Case Reports PT - Journal Article DEP - 20170113 PL - England TA - BMC Infect Dis JT - BMC infectious diseases JID - 100968551 RN - 0 (Anti-HIV Agents) RN - 0 (Antiprotozoal Agents) SB - IM MH - Acquired Immunodeficiency Syndrome/complications/drug therapy/*immunology MH - Adult MH - Anti-HIV Agents/adverse effects MH - Antiprotozoal Agents/therapeutic use MH - Antiretroviral Therapy, Highly Active/adverse effects MH - Brain/diagnostic imaging MH - CD4-Positive T-Lymphocytes/*immunology MH - CD8-Positive T-Lymphocytes/*immunology MH - Central Nervous System Diseases/chemically induced/diagnostic imaging/*immunology MH - HIV Infections/immunology MH - Humans MH - Immune Reconstitution Inflammatory Syndrome/chemically induced/diagnostic imaging/*immunology MH - Longitudinal Studies MH - Magnetic Resonance Imaging MH - Male MH - Spinal Cord/diagnostic imaging MH - T-Lymphocyte Subsets/immunology MH - Tomography, X-Ray Computed MH - Toxoplasmosis, Cerebral/complications/diagnostic imaging/drug therapy/*immunology PMC - PMC5237164 OTO - NOTNLM OT - Human immunodeficiency virus OT - Immune reconstitution inflammatory syndrome OT - Regulatory T cells OT - T cell subsets OT - Toxoplasmosis EDAT- 2017/01/15 06:00 MHDA- 2017/07/08 06:00 PMCR- 2017/01/13 CRDT- 2017/01/15 06:00 PHST- 2016/10/05 00:00 [received] PHST- 2016/12/22 00:00 [accepted] PHST- 2017/01/15 06:00 [entrez] PHST- 2017/01/15 06:00 [pubmed] PHST- 2017/07/08 06:00 [medline] PHST- 2017/01/13 00:00 [pmc-release] AID - 10.1186/s12879-016-2159-x [pii] AID - 2159 [pii] AID - 10.1186/s12879-016-2159-x [doi] PST - epublish SO - BMC Infect Dis. 2017 Jan 13;17(1):66. doi: 10.1186/s12879-016-2159-x.