Khatri Asma, Skalweit Marion J
Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA Department of Medicine, Case Medical Center, Cleveland, OH, USA.
Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA Case Western Reserve University School of Medicine, Cleveland, OH, USA
Int J STD AIDS. 2015 Sep;26(10):749-51. doi: 10.1177/0956462414553013. Epub 2014 Oct 13.
Immune reconstitution syndrome has rarely been reported in the context of syphilis infection. We report a patient with AIDS (CD4 42 cells/mm(3), viral load 344,000 cp/ml), treated previously for secondary syphilis and started on an integrase inhibitor-based single-tablet antiretroviral treatment regimen. After four weeks of antiretroviral treatment, he presented with non-tender, non-blanching erythematous nodules on his chest, an elevated rapid plasma reagin (1:1024) and immune reconstitution (CD4 154 cells/mm(3), HIV-RNA 130 cp/ml). A detailed workup to exclude opportunistic infections including secondary and neurosyphilis was performed. The patient was continued on antiretroviral treatment and treated empirically for neurosyphilis given cerebrospinal lymphocytosis and dermatopathology suggesting treponemal antigen-driven B-cell hyperplasia. We favour a diagnosis of immune reconstitution in association with prior syphilis infection attributable to rapid and potent immune restoration afforded by integrase inhibitors.
免疫重建综合征在梅毒感染背景下鲜有报道。我们报告一名艾滋病患者（CD4细胞计数为42个/mm³，病毒载量为344,000拷贝/ml），此前接受过二期梅毒治疗，开始接受基于整合酶抑制剂的单片剂抗逆转录病毒治疗方案。抗逆转录病毒治疗四周后，他胸部出现无痛性、非压之褪色的红斑结节，快速血浆反应素升高（1:1024）且免疫重建（CD4细胞计数为154个/mm³，HIV-RNA为130拷贝/ml）。进行了详细检查以排除包括二期梅毒和神经梅毒在内的机会性感染。鉴于脑脊液淋巴细胞增多和皮肤病理学提示梅毒螺旋体抗原驱动的B细胞增生，该患者继续接受抗逆转录病毒治疗并接受神经梅毒的经验性治疗。我们倾向于诊断为与既往梅毒感染相关的免疫重建，这归因于整合酶抑制剂带来的快速而有效的免疫恢复。
