Clinical and radiological deterioration in a patient with ... - Springer Link

2 downloads 0 Views 175KB Size Report
e-mail: adelard.debacker@skynet.be. Tel.: +32-9-2246513. Fax: +32-9-2246128. K. J. Mortelé. Department of Radiology, Division of. Abdominal Imaging and ...
Eur Radiol (2005) 15: 2264–2267 DOI 10.1007/s00330-005-2684-2

CHEST

A. I. De Backer K. J. Mortelé P. Bomans B. L. De Keulenaer I. J. Vanschoubroeck M. M. Kockx

Clinical and radiological deterioration in a patient with AIDS

Received: 22 August 2004 Revised: 16 November 2004 Accepted: 11 January 2005 Published online: 17 February 2005 # Springer-Verlag 2005

B. L. De Keulenaer Intensive Care Unit, Royal Darwin Hospital, Rocklands, 0810 Tiwi, NT, Australia

and tuberculosis is often characterized by miliary spreading of disease in these patients, it is important to recognize this phenomenon.

M. M. Kockx Department of Pathology, Ziekenhuisnetwerk Antwerpen, Stuivenberg, Lange Beeldekensstraat 267, 2060 Antwerp, Belgium

Keywords Disseminated tuberculosis . Human immunodeficiency virus infection . Acquired immunodeficiency syndrome . Antiretroviral therapy . Paradoxical worsening

A. I. De Backer (*) Department of Radiology, General Hospital Sint-Lucas, Groenebriel 1, 9000 Ghent, Belgium e-mail: [email protected] Tel.: +32-9-2246513 Fax: +32-9-2246128 K. J. Mortelé Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA P. Bomans . I. J. Vanschoubroeck Department of Internal Medicine, Ziekenhuisnetwerk Antwerpen, Stuivenberg, Lange Beeldekensstraat 267, 2060 Antwerp, Belgium

Abstract Paradoxical clinical deterioration of miliary tuberculosis, characterized by pulmonary and abdominal manifestations, is reported in a patient with the acquired immunodeficiency syndrome, after initiation of treatment with highly active antiretroviral therapy. Paradoxical reaction was attributed to partial restoration of cell-mediated immunity related to highly effective antiretroviral therapy. Because tuberculosis has a high prevalence in HIV patients

Introduction Infection with the human immunodeficiency virus (HIV) is associated with a host of immunological defects, including depression of cell-mediated immunity. Cell-mediated immunity is the principle host defense against infection [1]. As a result, patients with the acquired immunodeficiency syndrome (AIDS) may develop, with increased frequency, symptomatic tuberculosis (TB), resulting in significant morbidity and mortality [2]. Also, in these patients clinical presenta-

tions of TB may be atypical and extrapulmonary manifestations have been reported more frequently [1]. Treatment of AIDS with highly active antiretroviral therapy (HAART) results in partial restoration of cell-mediated immunity and may result in paradoxical worsening of TB manifestations [3, 4]. This phenomenon is also described as the immune reconstitution syndrome (IRIS) [3, 4]. We report a case of paradoxical clinical deterioration of miliary TB with concurrent pulmonary and abdominal manifestations in the setting of immune reconstitution.

2265

Case report A 50-year-old heterosexual male, infected with HIV for 10 years, was admitted with a 1-year history of weight loss, general weakness, dry cough and cutaneous lesions in both axillary and inguinal regions. The patient had had no previous treatment for his HIV infection. Physical examination of chest and abdomen revealed slightly enlarged lymph nodes in the neck, the groin and axilla. Candida albicans lesions were noted in the mouth. Laboratory investigations showed hemoglobin 11.7 g/dl (12.9–15.9), C-reactive protein 1.1 mg/dl (