PMID- 28163944
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20201001
IS  - 2090-6625 (Print)
IS  - 2090-6633 (Electronic)
VI  - 2017
DP  - 2017
TI  - Immune Reconstitution Inflammatory Syndrome: Opening Pandora's Box.
PG  - 5409254
LID - 10.1155/2017/5409254 [doi]
LID - 5409254
AB  - One of the purposes of antiretroviral therapy (ART) is to restore the immune 
      system. However, it can sometimes lead to an aberrant inflammatory response and 
      paradoxical clinical worsening known as the immune reconstitution inflammatory 
      syndrome (IRIS). We describe a 23-year-old male, HIV1 infected with a rapid 
      progression phenotype, who started ART with TCD4+ of 53 cells/mm(3) (3,3%) and 
      HIV RNA = 890000 copies/mL (6 log). Four weeks later he was admitted to the 
      intensive care unit with severe sepsis. The diagnostic pathway identified 
      progressive multifocal leukoencephalopathy, digestive Kaposi sarcoma, and P. 
      aeruginosa bacteraemia. Five weeks after starting ART, TCD4+ cell count was 
      259 cells/mm(3) (15%) and HIV RNA = 3500 copies/mL (4 log). He developed 
      respiratory failure and progressed to septic shock and death. Those complications 
      might justify the outcome but its autopsy opened Pandora's box: cerebral and 
      cardiac toxoplasmosis was identified, as well as hemophagocytic syndrome, 
      systemic candidiasis, and Mycobacterium avium complex infection. IRIS remains a 
      concern and eventually a barrier to ART. Male gender, young age, low TCD4 cell 
      count, and high viral load are risk factors. The high prevalence of subclinical 
      opportunistic diseases highlights the need for new strategies to reduce IRIS 
      incidence.
FAU - Meireles, Mariana
AU  - Meireles M
AUID- ORCID: 0000-0002-5744-6738
AD  - Internal Medicine Department, Porto Hospital Centre, Porto, Portugal.
FAU - Souto Moura, Conceicao
AU  - Souto Moura C
AUID- ORCID: 0000-0002-7763-6272
AD  - Pathological Anatomy Department, Sao Joao Hospital Centre, Porto, Portugal.
FAU - Franca, Margarida
AU  - Franca M
AUID- ORCID: 0000-0001-6299-3237
AD  - Clinical Immunology Unit, Porto Hospital Centre, Porto, Portugal.
LA  - eng
PT  - Case Reports
DEP - 20170109
PL  - Egypt
TA  - Case Rep Infect Dis
JT  - Case reports in infectious diseases
JID - 101573243
PMC - PMC5253505
COIS- The authors have no conflict of interests to declare.
EDAT- 2017/02/07 06:00
MHDA- 2017/02/07 06:01
PMCR- 2017/01/09
CRDT- 2017/02/07 06:00
PHST- 2016/07/31 00:00 [received]
PHST- 2016/12/05 00:00 [accepted]
PHST- 2017/02/07 06:00 [entrez]
PHST- 2017/02/07 06:00 [pubmed]
PHST- 2017/02/07 06:01 [medline]
PHST- 2017/01/09 00:00 [pmc-release]
AID - 10.1155/2017/5409254 [doi]
PST - ppublish
SO  - Case Rep Infect Dis. 2017;2017:5409254. doi: 10.1155/2017/5409254. Epub 2017 Jan 
      9.