Kuttiatt Vijesh, Sreenivasa Prarthana, Garg Isha, Shet Anita
Department of Paediatrics, St John's National Academy of Health Sciences, Bangalore, India.
Scand J Infect Dis. 2011 Aug;43(8):664-8. doi: 10.3109/00365548.2011.574293. Epub 2011 May 2.
HIV-related immune reconstitution inflammatory syndrome (IRIS) is increasingly being recognized in regions with a high burden of opportunistic infections. We describe an unusual manifestation of IRIS- 'unmasking' cryptococcal lymphadenitis in a patient shortly after initiation of antiretroviral therapy. Epidemiology, clinical features and management of cryptococcal IRIS with reference to lymphadenitis presentation are briefly reviewed. Early and accurate diagnosis is essential for appropriate management. Standard antifungal therapy along with continuation of antiretroviral therapy is recommended. Cases with severe inflammation may benefit from anti-inflammatory drugs/corticosteroids. Unusual manifestations like lymphadenitis pose diagnostic difficulties in regions with a high prevalence of tubercular lymphadenitis.
在机会性感染负担较高的地区，与艾滋病病毒相关的免疫重建炎症综合征（IRIS）越来越受到关注。我们描述了一名患者在开始抗逆转录病毒治疗后不久出现的一种不寻常的IRIS表现——“揭露”隐球菌性淋巴结炎。本文简要回顾了隐球菌性IRIS的流行病学、临床特征及以淋巴结炎表现为参考的治疗方法。早期准确诊断对于恰当治疗至关重要。建议采用标准抗真菌治疗并继续进行抗逆转录病毒治疗。炎症严重的病例可能受益于抗炎药物/皮质类固醇。在结核性淋巴结炎高发地区，像淋巴结炎这样的不寻常表现会带来诊断困难。
