PMID- 37170352 OWN - NLM STAT- MEDLINE DCOM- 20230515 LR - 20230515 IS - 1742-6405 (Electronic) IS - 1742-6405 (Linking) VI - 20 IP - 1 DP - 2023 May 11 TI - A case of syphilis associated with immune reconstitution inflammatory syndrome and review of the literature. PG - 28 LID - 10.1186/s12981-023-00522-2 [doi] LID - 28 AB - BACKGROUND: Immune reconstitution inflammatory syndrome (IRIS) associated with syphilis has rarely been described in HIV-infected patients. Diagnosis can be challenging because it is not always possible to discern it from a recent infection or a worsening of an undiagnosed one. CASE PRESENTATION: An HIV-positive 42-year-old man with a poor compliance history of antiretroviral therapy presented at our unit and complained of ocular symptoms. Ocular syphilis diagnosis was posed after initial misdiagnosing with cytomegalovirus infection, and antiretroviral therapy compliance improved after switching to a bictegravir-based regimen. Despite intravenous (IV) penicillin, we observed an initial worsening with the appearance of new skin lesions, and IRIS syphilis was suspected. In the literature, 14 cases of IRIS syphilis are described, all regarding male patients. Seven were HIV naive to therapy, and 7 HIV-experienced with poor therapy compliance. Basal syphilis serology was negative in ten, with subsequent seroconversion after the development of IRIS. IRIS-syphilis development was observed after a median time of 28 days from ART initiation; 10 cases were considered "unmasking-IRIS" and 4 "paradoxical-IRIS". Skin and ocular involvement were the most often reported. In most cases, it was not necessary to use a systemic steroid. A good outcome was reported in 12. CONCLUSIONS: Syphilis should be considered in differential diagnosis with other diseases associated with IRIS. A negative syphilis serology before beginning antiretroviral therapy could convey the impression that syphilis has been ruled out. Whereas a high index of suspicion should be maintained when symptoms suggestive of syphilis, such as ocular and skin manifestations, are noticed after therapy has begun. CI - (c) 2023. The Author(s). FAU - Pipito, Luca AU - Pipito L AD - Infectious and Tropical Diseases Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, Palermo, Italy. AD - Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone", Via del Vespro 129, 90127, Palermo, Italy. AD - Palermo Fast-Track City, Casa Dei Diritti, Via Liberta 45, 90143, Palermo, Italy. FAU - Medaglia, Alice Annalisa AU - Medaglia AA AD - Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone", Via del Vespro 129, 90127, Palermo, Italy. AD - Palermo Fast-Track City, Casa Dei Diritti, Via Liberta 45, 90143, Palermo, Italy. FAU - Trizzino, Marcello AU - Trizzino M AD - Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone", Via del Vespro 129, 90127, Palermo, Italy. AD - Palermo Fast-Track City, Casa Dei Diritti, Via Liberta 45, 90143, Palermo, Italy. FAU - Bonura, Silvia AU - Bonura S AD - Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone", Via del Vespro 129, 90127, Palermo, Italy. AD - Palermo Fast-Track City, Casa Dei Diritti, Via Liberta 45, 90143, Palermo, Italy. FAU - Gioe, Claudia AU - Gioe C AD - Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone", Via del Vespro 129, 90127, Palermo, Italy. AD - Palermo Fast-Track City, Casa Dei Diritti, Via Liberta 45, 90143, Palermo, Italy. FAU - Di Carlo, Paola AU - Di Carlo P AD - Infectious and Tropical Diseases Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, Palermo, Italy. AD - Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone", Via del Vespro 129, 90127, Palermo, Italy. AD - Palermo Fast-Track City, Casa Dei Diritti, Via Liberta 45, 90143, Palermo, Italy. FAU - Colomba, Claudia AU - Colomba C AD - Infectious and Tropical Diseases Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, Palermo, Italy. AD - Pediatric Infectious Diseases Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, 90127, Palermo, Italy. AD - Palermo Fast-Track City, Casa Dei Diritti, Via Liberta 45, 90143, Palermo, Italy. FAU - Cascio, Antonio AU - Cascio A AD - Infectious and Tropical Diseases Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, Palermo, Italy. antonio.cascio03@unipa.it. AD - Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone", Via del Vespro 129, 90127, Palermo, Italy. antonio.cascio03@unipa.it. AD - Palermo Fast-Track City, Casa Dei Diritti, Via Liberta 45, 90143, Palermo, Italy. antonio.cascio03@unipa.it. LA - eng PT - Case Reports PT - Journal Article PT - Review DEP - 20230511 PL - England TA - AIDS Res Ther JT - AIDS research and therapy JID - 101237921 SB - IM MH - Humans MH - Male MH - Adult MH - *HIV Infections/complications/drug therapy MH - *Syphilis/diagnosis/drug therapy MH - *Immune Reconstitution Inflammatory Syndrome/diagnosis/etiology PMC - PMC10176857 OTO - NOTNLM OT - HIV OT - IRIS OT - Paradoxical OT - Syphilis OT - Unmasking COIS- The authors declare that they have no competing interests. EDAT- 2023/05/12 01:07 MHDA- 2023/05/15 11:42 PMCR- 2023/05/11 CRDT- 2023/05/11 23:53 PHST- 2023/02/22 00:00 [received] PHST- 2023/05/02 00:00 [accepted] PHST- 2023/05/15 11:42 [medline] PHST- 2023/05/12 01:07 [pubmed] PHST- 2023/05/11 23:53 [entrez] PHST- 2023/05/11 00:00 [pmc-release] AID - 10.1186/s12981-023-00522-2 [pii] AID - 522 [pii] AID - 10.1186/s12981-023-00522-2 [doi] PST - epublish SO - AIDS Res Ther. 2023 May 11;20(1):28. doi: 10.1186/s12981-023-00522-2.