PMID- 31804330
OWN - NLM
STAT- MEDLINE
DCOM- 20191219
LR  - 20220411
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Print)
IS  - 0025-7974 (Linking)
VI  - 98
IP  - 49
DP  - 2019 Dec
TI  - Non-traumatic perforation of the jejunum in a human immunodeficiency 
      virus-infected patient receiving combination antiretroviral therapy: A case 
      report.
PG  - e18163
LID - 10.1097/MD.0000000000018163 [doi]
LID - e18163
AB  - RATIONALE: Non-traumatic bowel perforation caused by cytomegalovirus (CMV) and 
      Mycobacterium avium complex (MAC) infections has become rare among patients with 
      acquired immunodeficiency syndrome (AIDS) in the era of combination 
      antiretroviral therapy (cART); however, CMV-associated and MAC-related immune 
      reconstitution inflammatory syndrome (IRIS) has subsequently emerged owing to the 
      wide use of integrase inhibitor-based regimens. Here we report a case of 
      spontaneous perforation of the jejunum in a patient with human immunodeficiency 
      virus (HIV) infection with good compliance to cART. PATIENT CONCERNS: A 
      32-year-old HIV-infected man developed CMV disease and DMAC infection, as 
      unmasking IRIS, 3 days after the initiation of cART. After appropriate treatment 
      for opportunistic infections, intermittent fever with enlarged lymph nodes in the 
      abdomen occurred as paradoxical IRIS. The patient was administered prednisolone 
      with subsequent tapering according to his clinical condition. DIAGNOSES: 
      Unexpected perforation of hollow organ during the titration of steroid dose with 
      clinical presentations of severe abdominal pain was diagnosed by chest 
      radiography. INTERVENTIONS: He underwent surgical repair with peritoneal 
      toileting smoothly. OUTCOMES: He was discharged well with a clean surgical wound 
      on post-operative day 10. LESSONS: Bowel perforation may be a life-threatening 
      manifestation of IRIS in the era of cART. Steroids should be avoided, if 
      possible, to decrease the risk of bowel perforation, especially in IRIS occurred 
      after opportunistic diseases involving the gastrointestinal tract.
FAU - Lee, Yi-Chien
AU  - Lee YC
AD  - Department of Internal Medicine, Fu Jen Catholic University Hospital.
AD  - School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei 
      City.
FAU - Chiou, Chien-Chun
AU  - Chiou CC
AD  - Department of Dermatology, Ditmanson Medical Foundation Chia-Yi Christian 
      Hospital, Chia-Yi.
FAU - Wang, Jann-Tay
AU  - Wang JT
AD  - Department of Internal Medicine, National Taiwan University Hospital and National 
      Taiwan University College of Medicine, Taipei.
AD  - Institute for Infectious Diseases and Vaccinology, National Health Research 
      Institutes.
FAU - Yang, Yi-Chun
AU  - Yang YC
AD  - Department of Nursing, Ditmanson Medical Foundation Chia-Yi Christian Hospital, 
      Chia-Yi, Taiwan.
FAU - Tung, Shao-Hsien
AU  - Tung SH
AD  - Department of Internal Medicine, Fu Jen Catholic University Hospital.
FAU - Hsieh, Szu-Min
AU  - Hsieh SM
AD  - Department of Internal Medicine, National Taiwan University Hospital and National 
      Taiwan University College of Medicine, Taipei.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - IM
MH  - AIDS-Related Opportunistic Infections
MH  - Adult
MH  - Antiretroviral Therapy, Highly Active
MH  - Cytomegalovirus Infections/*complications
MH  - HIV Infections/*complications/drug therapy
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*complications
MH  - Intestinal Perforation/*etiology
MH  - Jejunal Diseases/*etiology
MH  - Male
MH  - Mycobacterium avium-intracellulare Infection/*complications
PMC - PMC6919416
COIS- Ethics approval and informed consent: In our institution, only an informed 
      consent from the patient should be acquired while research of case report was 
      conducted, so the need for ethical approval was waived. A written informed 
      consent was obtained from the patient for publication of this report. The authors 
      declare that they have no conflict of interests.
EDAT- 2019/12/06 06:00
MHDA- 2019/12/20 06:00
PMCR- 2019/12/10
CRDT- 2019/12/06 06:00
PHST- 2019/12/06 06:00 [entrez]
PHST- 2019/12/06 06:00 [pubmed]
PHST- 2019/12/20 06:00 [medline]
PHST- 2019/12/10 00:00 [pmc-release]
AID - 00005792-201912060-00029 [pii]
AID - MD-D-19-02460 [pii]
AID - 10.1097/MD.0000000000018163 [doi]
PST - ppublish
SO  - Medicine (Baltimore). 2019 Dec;98(49):e18163. doi: 10.1097/MD.0000000000018163.