Pseudotumoral abdominal granuloma concomitant with immune reconstitution after anti-retroviral treatment

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 .