L. Fonquernie et al., Pseudotumoral abdominal granuloma concomitant with immune reconstitution after anti-retroviral treatment, PRESSE MED, 29(4), 2000, pp. 186-187
Citations number
5
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
BACKGROUND: Use of powerful multiple-drug antiretroviral regimens can signi
ficantly raise CD4+ counts restoring immune function, but in certain cases,
leading to inflammatory reactions.
CASE REPORT: An HIV-infected patient developed a mycobacteriosis of the dig
estive tract when his CD4 count fell below 5/mm(3). He was given antimycoba
cterial treatment in combination with an effective triple an antiretroviral
regimen; At two years, the clinical situation was controlled with persiste
nt optimal response (CD4=338/mm(3) HIV-RNA <500 copies/ml); the antimycobac
terial regimen was discontinued. One year later the patient still had a CD4
+ count above 500/mm(3) but developed a voluminous mesenteric mass invaded
by a CD68+ histiocyte proliferation. No causal agent could be identified. T
he clinical course was favorable after reintroducing antimycobacterial trea
tment combined with short-term corticosteroid therapy.
DISCUSSION: Reconstitution of the immune system after long-term use of the
new antiretroviral therapies mises the question of whether anti-infectious
prophylaxis should be maintained. However, possible reactions to earlier pa
thogens after restoration of specific immunity would warrant secondary prop
hylaxis even in patients responding to powerful antiretroviral combinations
.