| Title | Tegumentary leishmaniasis as the cause of immune reconstitution inflammatory syndrome in a patient co-infected with human immunodeficiency virus and Leishmania guyanensis. | | Author(s) | Chrusciak-Talhari A, Ribeiro-Rodrigues R, Talhari C, Silva RM, Ferreira LC, Botileiro SF, Santos LO, Dietze R, Talhari S | | Institution | Fundação de Medicina Tropical do Amazonas, Manaus, Amazonas, Brazil. | | Source | Am J Trop Med Hyg 2009 Oct; 81(4):559-64. | | MeSH | Adult
Animals
Anti-Infective Agents
Anti-Inflammatory Agents
Antiretroviral Therapy, Highly Active
HIV Infections
Humans
Immune Reconstitution Inflammatory Syndrome
Leishmania guyanensis
Leishmaniasis, Mucocutaneous
Male
Prednisone
Skin
| | Abstract | We report a case of immune reconstitution inflammatory syndrome (IRIS) in a 32-year-old man infected with human immunodeficiency virus and Leishmania guyanensis. Three months after initiation of highly active anti-retroviral therapy (HAART), the patient had disseminated cutaneous leishmaniasis and started anti-leishmanial therapy. The patient's leishmaniasis manifestations during HAART ranged form an anergic response (46 CD4+ T cells/microL) to a disseminated cutaneous leishmaniasis (112 CD4+ T cells/microL). Eight weeks later (168 CD4+ T cells/microL, skin biopsy specimens showed inflammatory infiltrates with no detectable amastigotes. The patient then became comatose. Prednisone therapy (60 mg/day) was initiated with a significant improvement within 48 hours. Three months later (CD4+ T cell count = 184 cell/microL), localized, classic, cutaneous leishmaniasis developed in the patient and anti-leishmanial treatment was re-introduced. On that occasion, frequency of T regulatory cells was 1.82% of all CD4+ cells. Our data suggest a pivotal role for CD4+ T cells in the onset of IRIS and lesion ulceration and their association with a low frequency of T regulatory cells. | | Language | eng | | Pub Type(s) | Case Reports
Journal Article
| | PubMed ID | 19815866 |
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