Severe BCG immune reconstitution inflammatory syndrome lymphadenitis successfully managed with pre-antiretroviral counseling and a non-surgical approach: a case report.

Autor: Machava P; Hospital Central de Maputo, Maputo, Mozambique., Joaquim W; Universidade Eduardo Mondlane Faculdade de Medicina, Maputo, Mozambique. jwinete@gmail.com., Borrell J; University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA., Richardson S; University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA., Cassia U; Universidade Eduardo Mondlane Faculdade de Medicina, Maputo, Mozambique., Sidat M; Universidade Eduardo Mondlane Faculdade de Medicina, Maputo, Mozambique., Maieca A; Universidade Eduardo Mondlane Faculdade de Medicina, Maputo, Mozambique., Massitela C; Universidade Eduardo Mondlane Faculdade de Medicina, Maputo, Mozambique., Quelhas Y; Hospital Central de Maputo, Maputo, Mozambique., Mucuila C; Hospital Central de Maputo, Maputo, Mozambique., Elias B; Hospital Central de Maputo, Maputo, Mozambique., da Rocha M; Hospital Central de Maputo, Maputo, Mozambique., Schaaf HS; Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa., Buck WC; Hospital Central de Maputo, Maputo, Mozambique.; University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA.
Jazyk: angličtina
Zdroj: AIDS research and therapy [AIDS Res Ther] 2024 Apr 27; Vol. 21 (1), pp. 25. Date of Electronic Publication: 2024 Apr 27.
DOI: 10.1186/s12981-024-00614-7
Abstrakt: Background: Bacillus Calmette-Guérin (BCG) reactions are the most common cause of immune reconstitution inflammatory syndrome (IRIS) in HIV-positive infants who initiate antiretroviral therapy (ART). There is limited evidence regarding the incidence of BCG-IRIS; however, reports from outpatient cohorts have estimated that 6-9% of infants who initiated ART developed some form of BCG-IRIS within the first 6 months. Various treatment approaches for infants with BCG-IRIS have been reported, but there is currently no widely accepted standard-of-care.
Case Presentation: A 5-month-old male HIV-exposed infant BCG vaccinated at birth was admitted for refractory oral candidiasis, moderate anemia, and moderate acute malnutrition. He had a HIV DNA-PCR collected at one month of age, but the family never received the results. He was diagnosed with HIV during hospitalization with a point-of-care nucleic acid test and had severe immune suppression with a CD4 of 955 cells/µL (15%) with clinical stage III disease. During pre-ART counseling, the mother was educated on the signs and symptoms of BCG-IRIS and the importance of seeking follow-up care and remaining adherent to ART if symptoms arose. Three weeks after ART initiation, he was readmitted with intermittent subjective fevers, right axillary lymphadenopathy, and an ulcerated papule over the right deltoid region. He was subsequently discharged home with a diagnosis of local BCG-IRIS lymphadenitis. At six weeks post-ART initiation, he returned with suppurative lymphadenitis of the right axillary region that had completely eviscerated through the skin without signs of disseminated BCG disease. He was then started on an outpatient regimen of topical isoniazid, silver nitrate, and oral prednisolone. Throughout this time, the mother maintained good ART adherence despite this complication. After 2.5 months of ART and one month of specific treatment for the lymphadenitis, he had marked mass reduction, improved adenopathy, increased CD4 count, correction of anemia, and resolution of his acute malnutrition. He completely recovered and was symptom free two months after initial treatment without surgical intervention.
Conclusions: This case details the successful management of severe suppurative BCG-IRIS with a non-surgical approach and underlines the importance of pre-ART counseling on BCG-IRIS for caregivers, particularly for infants who initiate ART with advanced HIV.
(© 2024. The Author(s).)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje