Cutaneous manifestations in immune restoration syndrome occurring during tuberculosis therapy

Introduction. Immune restoration syndrome was first described in 1998 and i nvolved mycobacterium avium complex. We report the case of a patient with a cquired immunodeficiency syndrome who had disseminated cutaneous lesions du e to Mycobacterium tuberculosis, following initiation of highly active anti retroviral therapy. Case report. A 42 year-old HIN-infected man, was admitted for fever, cough, nocturnal sweat and impaired of general condition. He had a viral load of 127 200 copies/ml and 199/ml CD4 T-cells, He was treated with triple tuberc ulosis combination therapy according to tuberculous contagium. positivity o f the tuberculin intradermoreaction (15 mm) and right upper lung nodule on thoracic scan, M, tuberculosis was not found, Fever improved at day 3. High ly active antiretroviral therapy with zidovudine, lamivudine, indinavir, wa s started at day ii and 33 days after, fever and dermohypodermal nodules wi th necrotising evolution appeared, Skin biopsy specimen showed tuberculoid granuloma. The levels of viral load and CD4 T-cells were less than 200 copi es/ml and 497/ml respectively. Fever and cutaneous lesions spontaneously re solved without changing therapy, Discussion. immune restoration syndrome appears after initiation of antiret rovral therapy, in patients with advanced HIV infection and without prophyl actic treatment versus MAC. This case report probably involves mycobacteriu m tuberculosis, Bacterial lysis and immune restoration take part in cutaneo us pathogenesis, Subclinical mycobacterial infection should be monitored du ring initiation of antiretroviral therapy in patients with advanced HIV inf ection.