Immune reconstitution inflammatory syndrome associated with dermatophytoses in two HIV-1 positive patients in rural Tanzania: a case report
| Autor: | Mapesi, Herry, Ramírez, Adrià, Tanner, Marcel, Hatz, Christoph, Letang, Emilio, KIULARCO Study Group |
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| Předmět: |
0301 basic medicine
CD4-Positive T-Lymphocytes Cyclopropanes Male medicine.medical_treatment tiña humanos benzoxacinas HIV Infections Case Report Esophageal candidiasis Deoxycytidine Tanzania 030207 dermatology & venereal diseases chemistry.chemical_compound 0302 clinical medicine Tinea Immune Reconstitution Inflammatory Syndrome Antiretroviral Therapy Highly Active medicine.diagnostic_test Immunosuppression adulto linfocitos T CD4-positivos Infectious Diseases Alkynes Prednisolone Female VIH-1 medicine.drug Adult medicine.medical_specialty Efavirenz 030106 microbiology Organophosphonates Emtricitabine 03 medical and health sciences adenina síndrome inflamatorio de reconstitución inmunitaria Immune reconstitution inflammatory syndrome medicine VIH (Virus) Humans Immunosupressió business.industry HIV (Viruses) Adenine HIV medicine.disease Dermatology desoxicitidina Benzoxazines CD4 Lymphocyte Count recuento de linfocitos CD4 chemistry Immunology Africa HIV-1 Liver function infecciones por VIH organofosfonatos business Liver function tests |
| Zdroj: | Recercat. Dipósit de la Recerca de Catalunya instname BMC Infectious Diseases Dipòsit Digital de la UB Universidad de Barcelona |
| Popis: | Background: Immune reconstitution inflammatory syndrome associated with dermatophytoses (tinea-IRIS) may cause considerable morbidity. Yet, it has been scarcely reported and is rarely considered in the differential diagnosis of HIV associated cutaneous lesions in Africa. If identified, it responds well to antifungals combined with steroids. We present two cases of suspected tinea-immune reconstitution inflammatory syndrome from a large HIV clinic in rural Tanzania. Cases presentation: A first case was a 33 years-old female newly diagnosed HIV patient with CD4 count of 4 cells/mu L (0 %), normal complete blood count, liver and renal function tests was started on co-formulated tenofovir/emtricitabine/efavirenz and prophylactic cotrimoxazole. Two weeks later she presented with exaggerated inflammatory hyperpigmented skin plaques with central desquamation, active borders and scratch lesions on the face, trunk and lower limbs. Tinea-IRIS was suspected and fluconazole (150 mg daily) and prednisolone (1 mg/Kg/day tapered down after 1 week) were given. Her symptoms subsided completely after 8 weeks of treatment, and her next CD4 counts had increased to 134 cells/mu L (11 %). The second case was a 35 years-old female newly diagnosed with HIV. She had 1 CD4 cell/ muL (0 %), haemoglobin 9.8 g/dl, and normal renal and liver function tests. Esophageal candidiasis and normocytic-normochromic anaemia were diagnosed. She received fluconazole, prophylactic cotrimoxazole and tenofovir/emtricitabine/efavirenz. Seven weeks later she presented with inflammatory skin plaques with elevated margins and central hyperpigmentation on the trunk, face and limbs in the frame of a good general recovery and increased CD4 counts (188 cells/mu L, 6 %). Tinea-IRIS was suspected and treated with griseofulvin 500 mg daily and prednisolone 1 mg/Kg tapered down after 1 week, with total resolution of symptoms in 2 weeks. Conclusion: The two cases had advanced immunosuppression and developed de-novo exaggerated manifestation of inflammatory lesions compatible with tinea corporis and tinea facies in temporal association with antiretroviral treatment initiation and good immunological response. This is compatible with unmasking tinea-IRIS, and reminds African clinicians about the importance of considering this entity in the differential diagnosis of patients with skin lesions developing after antiretroviral treatment initiation. We would like to acknowledge the contribution made by Nora Tan from Stanford University in reviewing the manuscript. We would like to acknowledge the contributions from all members of Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) study group. The KIULARCO and the Chronic Diseases Clinic of Ifakara (CDCI) receive financial support from the Government of the Canton of Basel, Switzerland, the Swiss Tropical and Public Health Institute, the Ifakara Health Institute, the Government of Tanzania, and USAID through TUNAJALI-Deloitte. The members of the KIULARCO Study Group are: Aschola Asantiel, Manuel Battegay, AdolphinaChale, Diana Faini, Ingrid Felger, Gideon Francis, Hansjakob Furrer, Anna Gamell, Tracy Glass, Christoph Hatz, Specioza Hwaya, Bryson Kasuga, Namvua Kimera, Yassin Kisunga, Thomas Klimkait, Emilio Letang, Antonia Luhombero, Lameck B Luwanda, Herry Mapesi, Leticia Mbwile, Mengi Mkulila, Julius Mkumbo, Margareth Mkusa, Dorcus K Mnzava, Germana Mossad, Dolores Mpundunga, Athumani Mtandanguo, Kim D Mwamelo, Selerine Myeya, Sanula Nahota, Regina Ndaki, Agatha Ngulukila, Alex John Ntamatungiro, Leila Samson, George Sikalengo, Marcel Tanner, Fiona Vanobberghen, Aneth V Kalinjuma and Maja Weisser. |
| Databáze: | OpenAIRE |
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