Department of Endocrinology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Intern Med J. 2011 Sep;41(9):699-703. doi: 10.1111/j.1445-5994.2011.02546.x.
We report the case of a 56-year-old man with the rare autoimmune pathologies of alternating hypothyroidism and hyperthyroidism due to thyroid-stimulating hormone receptor antibodies, and rheumatoid arthritis as manifestations of a human immunodeficiency virus-related immune reconstitution inflammatory syndrome. The patient also developed overt progression of a pre-existing skin malignancy that may also be related. This case highlights immune reconstitution syndrome as an important differential diagnosis following antiretroviral therapy commencement, and that a high index of suspicion should be maintained for this rare but important cluster of conditions. Furthermore, the patient's genetic predisposition to autoimmunity provides helpful insights into the pathogenesis of these disorders.
我们报告了一例 56 岁男性病例，其罕见的自身免疫性疾病表现为甲状腺刺激激素受体抗体引起的交替性甲状腺功能减退症和甲状腺功能亢进症，以及类风湿关节炎，这些都是人类免疫缺陷病毒相关免疫重建炎症综合征的表现。该患者还出现了先前存在的皮肤恶性肿瘤的明显进展，这也可能与之相关。该病例强调了免疫重建综合征是抗逆转录病毒治疗开始后的一个重要鉴别诊断，对于这种罕见但重要的疾病群，应保持高度怀疑。此外，患者对自身免疫的遗传易感性为这些疾病的发病机制提供了有帮助的见解。
