Advanced human immunodeficiency virus (HIV) does not affect ability to utilize lymphadenopathy in assessment of drug reaction with eosinophilia and systemic symptoms syndrome in HIV and tuberculosis: Prospective comparative study.

Autor:	Machona MS; Department of Medicine, Division of Dermatology, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa., Muloiwa R; Department of Paediatrics, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa., Porter M; Department of Medicine, Division of Allergy and Clinical Immunology, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa.; Combined Drug Allergy Clinic, Groote Schuur Hospital, Cape Town, South Africa., Peter J; Department of Medicine, Division of Allergy and Clinical Immunology, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa.; Combined Drug Allergy Clinic, Groote Schuur Hospital, Cape Town, South Africa., Lehloenya RJ; Department of Medicine, Division of Dermatology, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa.; Combined Drug Allergy Clinic, Groote Schuur Hospital, Cape Town, South Africa.
Jazyk:	angličtina
Zdroj:	The journal of allergy and clinical immunology. Global [J Allergy Clin Immunol Glob] 2024 May 03; Vol. 3 (3), pp. 100276. Date of Electronic Publication: 2024 May 03 (Print Publication: 2024).
DOI:	10.1016/j.jacig.2024.100276
Abstrakt:	Background: RegiSCAR validation criteria for drug reaction with eosinophilia and systemic symptoms (DRESS) includes lymphadenopathy, a frequent feature of both tuberculosis (TB) and human immunodeficiency virus (HIV). TB is the most common HIV-associated coinfection. Advanced HIV is associated with lymph node (LN) fibrosis. It is not clear if this negatively affects case validation in HIV-associated DRESS. To answer this question, we designed a prospective descriptive study to assess lymphadenopathy in various combinations of comorbid HIV, TB, and DRESS. Objectives: We sought to describe the prevalence of DRESS-associated lymphadenopathy and characterize LN quality, size, and distribution in a high HIV-TB burden setting over time. Methods: We prospectively and systematically examined LN in 25 consecutive acute DRESS cases hospitalized at a South African tertiary-care center and 10 hospitalized non-DRESS HIV-TB coinfected controls. Results: Fourteen (56%) of 25 patients were HIV infected, with a median (interquartile range) CD4 count of 254 (66-478) cells/mm³, and 7 of 14 were coinfected with TB. Using RegiSCAR criteria, 12 (46%) of 25 were definite DRESS cases, 8 (31%) of 25 probable, and 5 (23%) of 25 possible. Possible cases were excluded in the analysis. Fifteen (75%) of 20 subjects had LN in ≥2 anatomic sites, including all 7 patients with HIV-TB coinfection. In contrast, 1 (20%) of 5 hospitalized non-DRESS HIV-TB coinfected controls had LN. Cervical LN, in 15 (88%) of 17, was most common, followed by axillary (76%) and inguinal (59%). Cervical LN ranged between 1 and 2 cm in size. Among the 8 (32%) of 25 subjects with follow-up data, LN had regressed in all within 6 weeks of stopping the offending drug and initiating TB treatment. There was no correlation with CD4 cell count and LN. Conclusion: Lymphadenopathy is a common feature of acute DRESS, even among HIV-TB-coinfected patients with advanced immunosuppression. Competing Interests: R.J.L.’s contribution was nonrated researcher support from the South African 10.13039/501100001321National Research Foundation (grant 121278). J.P.’s contribution was supported by a 10.13039/100000002National Institutes of Health 10.13039/100000061Fogarty career development award (K43TW011178-04). Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest. (© 2024 The Author(s).)
Databáze:	MEDLINE
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