Source: Annual Congress 2006 - Clinical aspects of tuberculosis
Disease area: Respiratory infections

Abstract

High efficacy anti-retroviral therapy partially corrects the immune defects caused by Human Immunodeficiency Virus (HIV) infection.
The use of anti-retroviral leads to the reconstitution of cellular immune function against infectious and non-infectious antigens, but can cause temporary worsening of the clinical state – Immune Reconstitution Syndrome (IRS).
The authors present a clinical case of a 41 year-old, white, male patient with an Acquired Immunodeficiency Syndrome, disseminated tuberculosis and skin Kaposi‘s Syndrome diagnosis since January 2005. He initiated anti-tuberculosis and anti-retroviral therapy with CD₄ counts of 61 cells/mm³.
The patient was admitted in Pulido Valente Hospital, on March 2005, for Undetermined Febrile Syndrome. On admission, the patient had a fever (38º C), showed weight loss, behavior changes, generalized enlarged lymph nodes, liver and spleen and worsening of the skin Kaposi lesions.
The CD₄ count was 225 cells/mm³ (20%) and the viral load HIV1-128 copies/cm³. Lymph node biopsies were positive on a direct exam for RAAB but negative for the other mycobacteriologic exams. Spinal tab showed the presence of Cryptococcus neoformans. Therapy with Amphotericin B lead to resolution of the neurological symptoms and disappearance of Cryptococcus neoformans from the liquor.
The other test did not show any changes.
Due to the worsening of the clinical presentation, fever persistence and exclusion of other possible diagnosis the authors considered the IRS hypothesis the most likely diagnosis. In this context, the patient began corticotherapy which led to marked clinical improvement, absence of fever, decrease in lymph node size and the Kaposi skin lesions.

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Citations should be made in the following way:
M. Tátá, S. Moreira, M. Man, A. Mineiro, P. Esteves, M. Serrado, A. Dinis (Lisboa, Portugal). Fever syndrome in AIDS and tuberculosis patient. Eur Respir J 2006; 28: Suppl. 50, 816

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